Pilonidal disease is a type of skin infection which typically occurs as a cyst between the cheeks of the buttocks and often at the upper end.

[1][2] Risk factors include obesity, family history, prolonged sitting, greater amounts of hair, and not enough exercise.

[5] Although usually found near the coccyx, the condition can also affect the navel, armpit, the cheek,[6] or the genital region,[7] though these locations are much rarer.

The presence of bacteria and low oxygen levels hamper wound healing and exacerbate a forming pilonidal cyst.

Correct diagnosis is important because all teratomas require consultation with an oncologist and complete surgical excision, if possible without any spillage.

[17] The most commonly performed surgery is for the pilonidal sinus complex to be surgically excised with the wound often left open to heal.

[19] A 2024 study involving 667 people found that, compared with tissue-removing surgery, minor procedures (such as draining and pit-picking) were associated with less pain, fewer complications and a faster recovery.

[20][21] Surgeons can also excise the sinus and repair with a reconstructive flap technique, such as a "cleft lift" procedure or Z-plasty, usually done under general anesthetic.

This approach is especially useful for complicated or recurring pilonidal disease, leaves little scar tissue and flattens the region between the buttocks, reducing the risk of recurrence.

[15] This approach typically results in a more rapid recovery than the traditional surgery, however there are fewer surgeons trained in the cleft lift procedure and it consequently may not be as accessible to patients, depending on their location.

Minimally invasive techniques with no wound and rapid return to full activities have been reported but await double blind randomised trials.

[17] Since the 2010s, a number of minimally invasive techniques have been developed, with the purpose of minimising the impact of surgery on patients and of achieving less pain and shorter recovery times.

There are a lot of different dressings and topical agents (creams or lotions) that are available for helping these open wounds to heal.

A 2022 systematic review brought together evidence from 11 studies that compared dressings and topical agents for treating open wounds after surgical treatment for pilonidal sinus of the buttocks.