This article reviews the current practices and evidence on the management of pilonidal disease in the pediatric population. Medical management, use of laser epilation, and minimally invasive surgical options are highlighted with a brief review of more invasive surgical options for refractory disease.
Pilonidal cysts occur due to hair entering the skin in the deep intergluteal cleft, as a result of normal bodily motion, forming sinuses to the skin and a cyst in the subcutaneous tissue with hair, inflammation, granulation tissue, and possibly even infection.
The first key to treatment is the resolution of infection including drainage of abscesses.
Asymptomatic sinuses/pits can be managed with hygiene and hair removal.
Current management of ongoing disease favors a minimally invasive approach, with a Gips or endoscopic procedure, in which pits/sinus tracts are excised with the removal of hair and curettage of the cavity.
Larger excisions are reserved for when these less invasive approaches have failed.
Pilonidal disease is a relatively common condition affecting adolescents and young adults and less commonly younger children. A spectrum of pilonidal conditions can be seen in children and adolescents including pilonidal cyst, pilonidal abscess, and pilonidal pits and sinuses ( Fig. 1 A, B ). Pilonidal disease is classically described as involving the midline natal (gluteal) cleft and tends to affect men more than women. Pilonidal disease can also occur in the umbilicus but is far less common than in the natal cleft location.