Do Children with Pilonidal Disease Need Surgery? Exploring Treatment Options

Pilonidal disease is a chronic infection of the skin in the area between the buttocks. It occurs when hair follicles become plugged and form a nest of hair and debris under the skin. This can cause pain, swelling, drainage and sometimes infection. Pilonidal disease is more common in teenagers and young adults, especially boys, who have thick or coarse body hair. In this blog post, we will answer some common questions about pilonidal disease in children and explain the available treatment options.

What are the symptoms of pilonidal disease?

The first symptom of pilonidal disease is usually pain in the tailbone region, especially when sitting. The pain can vary from mild to severe, depending on the extent of the infection. Some children may also notice a lump or swollen area in the crease between the buttocks, which may or may not drain pus or blood. The pus may have a foul smell and the skin around it may be red and tender. If the infection spreads, the child may also have fever, nausea and fatigue. It is important to seek medical attention right away if these symptoms occur.

What causes pilonidal disease?

The exact cause of pilonidal disease is not clear, but it is believed to be related to plugged hair follicles in the buttock crease. Any type of hair can cause problems, but coarse, thick or curly hair is more likely to grow into the skin rather than outward. This can create an indentation or pit in the skin, which can collect hair and other debris. This collection can then get infected and form an abscess or a sinus tract under the skin.

How is pilonidal disease diagnosed?

Pilonidal disease is diagnosed based on the symptoms and a physical examination of the buttock crease. The doctor may look for holes or pits in the skin that indicate a pilonidal sinus.

How is pilonidal disease treated?

The treatment of pilonidal disease depends on the severity and recurrence of the condition. Some of the treatment options include:

- Antibiotics: If the infection is mild, antibiotics may be prescribed to clear it up. The child will also need to keep the area clean and dry, shave or remove the hair around it, and avoid sitting for long periods of time.

- Drainage: If there is an abscess, it may need to be drained by a doctor. This can be done in the office or in the hospital under local or general anesthesia. The doctor will make a small cut in the skin and squeeze out the pus and debris. The wound will then be packed with gauze and covered with a bandage. The child will need to change the dressing daily and take antibiotics until it heals.

- Surgery: If there are multiple abscesses or sinus tracts, or if the infection keeps coming back, surgery may be needed to remove them. There are different types of surgery for pilonidal disease, such as excision, flap closure, or pit picking. The choice of surgery depends on several factors, such as the size and location of the lesions, the surgeon's preference and experience, and the child's preference and expectations. Surgery can be done as an outpatient procedure or require a short hospital stay. The recovery time can vary from a few days to several weeks, depending on the type of surgery and how well the wound heals.

- Minimally invasive surgical options: Some newer techniques have been developed to treat pilonidal disease with less pain, scarring and recurrence than traditional surgery. One of them is "crystalized phenol treatment", which involves debridment of the pits and putting a chemical called phenol into the sinus tracts to destroy them from inside. This can be done in the office under local anesthesia and does not require any stitches or dressings. The child can resume normal activities within a day or two. Other minimal invasive options are endoscopic surgery, and laser ablation. The minimal invasive procedures gained widespread acceptance due to increased comfort after surgery and faster return to the daily life.

Pilonidal disease can be cured with proper treatment, but there is always a chance of recurrence. The recurrence rate depends on several factors, such as:

- The type and extent of pilonidal disease

- The type and quality of treatment

- The child's compliance with hygiene measures

Some studies have found that laser hair removal can reduce the recurrence rate of pilonidal disease by preventing hair growth in the affected area.

If you suspect that your child has pilonidal disease, please contact your pediatric surgeon for diagnosis and treatment.