Pilonidal disease is one of the most common and challenging conditions in surgery. Pilonidal (pilo, hair; nidal, nest) is a collection of hairs which accumulate in the intergluteal cleft (above the tailbone), and form a cyst or collection of hairs beneath the skin. Human hair, the underlying source of pilonidal disease, contain microscopic barbs, or “hooks” on their surface, and once the hairs delve beneath the skin surface, they burrow deeper and deeper, forming the collection of hairs, or pilonidal cyst. Oddly enough, the culprit hairs may arise not from the hair around the cyst itself, but from the patient’s own hair on their head, or even, rarely, their pets hair. One theory proposes that rubbing together of the gluteal muscles during walking, may act as a mini vacuum pump, and suck the hair into the locale, so setting up the scenario for a pilonidal cyst.
The cysts may become infected, and form an abscess, which requires surgical drainage. Although drainage of the abscess and excision of the cyst sound like simple procedures, healing may be problematic and prolonged. Recurrent pilonidal disease may emerge several years after excision. Dr. Armstrong recently described the use of a novel antibiotic compound to treat recurrent pilonidal disease, without the need to resort to surgery. The use of topical 10% metronidazole resulted in healing of recurrent or persistent pilonidal disease in 93% of patients, in a recent research paper submitted by Dr. Armstrong and his research team.