Care at Children's

Infections that occur in the sacro-coccygeal area (at the upper part of the gluteal cleft/bottom crack) are referred to as pilonidal disease. These infections may result from developmental cysts or from deep hair follicles in that area. A developmental cyst may become infected or the deep hair follicles may produce hair that is trapped under the skin resulting in infection. Surrounding hair may also burrow into the skin making the problem worse. Pilonidal disease typically occurs in adolescents and young adults. Pain and troublesome drainage are the main symptoms.

If there is severe infection, treatment begins with a surgical clean-up, usually performed in the operating room. Long-term management involves local hygienic practices that we call “power-showering” (directing a detachable shower head directly on the area, and “vertical hygienic scrubbing” (scrubbing the gluteal cleft/bottom crack up-and-down with a soapy washcloth). These hygienic practices are performed every day. Hair removal in the surrounding skin using careful shaving of depilatories may help in some cases. Most patients can become symptom-free (no pain, no drainage) with combinations of surgical clean-ups and good hygienic practices.

Although other surgeons may recommend traditional “excisional treatment” (surgical removal of the involved area) for pilonidal disease, the pediatric surgeons at Penn State Children’s Hospital rarely find this necessary. Traditional “excisional treatment” has a high complication rate and often a prolonged recovery with significant activity restrictions and missed school.

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Symptoms, Diagnosis & Outlook


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

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