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Definition

Pilonidal dimple is a condition that can occur anywhere along the crease between the buttocks, which runs from the bone at the bottom of the spine (sacrum) to the anus.

Pilonidal dimple may appear as:

  • A pilonidal abscess, in which the hair follicle becomes infected and pus collects in the fat tissue
  • A pilonidal cyst, in which a cyst or hole forms if there has been an abscess for a long time
  • A pilonidal sinus, in which a tract grows under the skin or deeper from the hair follicle
  • A small pit or pore in the skin that contains dark spots or hair
Alternative Names

Pilonidal abscess; Pilonidal sinus; Pilonidal cyst; Pilonidal disease

Considerations

Symptoms may include:

  • Pus may drain to a small pit in the skin
  • Tenderness over the area after you are active or sit for a period of time
  • Warm, tender, swollen area near the tailbone
  • Fever (rare)

There may be no symptoms other than a small dent (pit) in the skin in the crease between the buttocks.

Common Causes

The cause of pilonidal disease is not clear. It is thought to be caused by hair growing into the skin in the crease between the buttocks.

This problem is more likely to occur in people who:

  • Are obese
  • Experienced trauma or irritation in the area
  • Have excess body hair
  • Sit for long periods of time
  • Wear tight clothing
Home Care

It may help to keep the area clean and dry and remove hair regularly to prevent infection.

Call your health care provider if

Call your health care provider if you notice any of the following around the pilonidal cyst:

  • Drainage of pus
  • Redness
  • Swelling
  • Tenderness
What to expect at your health care provider's office

You will be asked for your medical history and given a physical examination. Sometimes you may be asked for the following information:

  • Has there been any change in the appearance of the pilonidal cyst?
  • Has there been any drainage from the area?
  • Do you have any other symptoms?

Rarely, a CT scan is done.

Pilonidal disease that causes no symptoms does not need to be treated.

A pilonidal abscess may be opened, drained, and packed with gauze. Antibiotics may be used if there is an infection spreading in the skin or you also have another, more severe illness.

Other surgeries that may be needed include:

  • Removal (excision) of the diseased area
  • Skin grafts
  • Surgery to remove an abscess that returns
References

Stafford SJ, Klein MD. Pilonidal sinus and abscess. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 336.6.

Nelson H, Cima RR. Anus. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 51.

Humphries AF, Duncan JE. Evaluation and management of pilonidal disease. Surg Clin North Am. 2010;90:113-124.

Reviewed By

Review Date: 11/07/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Related Questions

Can a pilonidal sinus be harmless even if it is not infected?

A pilonidal sinus is a dimple that appears in the mid-line cleft at the level of the coccyx and is seen relatively frequently in infants. Overall, there is no evidence that a little pilonidal sinus provokes any problems for a young patient.


Pilonidal cyst?

DefinitionA pilonidal cyst is a small pit, or dimpled area that can occur anywhere along the crease between the buttocks (sacral area).Alternative NamesSacral dimple; Pilonidal dimple; Pilonidal sinusConsiderationsMost pilonidal cysts are pits or small depressions that are present from birth. They may range from a small dimple to a deep tract with hair in or around it.There may be more than one pit present. Very rarely, the pilonidal cyst may reach the spinal cord.A pilonidal cyst may become infected, forming what is called a pilonidal abscess. This may require surgical drainage. If repeated infection occurs, surgery may be done to remove it.Common CausesThe cause of pilonidal cysts is not certain. These cysts may be congenital (present from birth). In some cases, they might be caused by hair growing into the skin. This may occur with excess body hair, tight clothing, or sitting for long periods of time.Home CareIt may be helpful to keep the area clean and dry and remove hair regularly to help prevent infection.Call your health care provider ifCall your health care provider if you notice swelling, redness, drainage, or tenderness around the pilonidal cyst.What to expect at your health care provider's officeYou will be asked for your medical history and given a physical examination. Sometimes you may be asked for the following information:Has there been any change in the appearance of the pilonidal cyst?Has there been any drainage from the dimple?Are any other symptoms developing?What other symptoms are also present?Is there any numbness or loss of movement in the legs?Has there been any change in bladder control?Most pilonidal cysts will not cause any symptoms and can be left alone. Rarely, tests may be done to determine if the pilonidal cyst extends to the spinal cord.ReferencesKlein MD, Thomas RP. Surgical conditions of the anus, rectum, and colon. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 341.Nelson H, Cima RR. Anus. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 51.


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