From
Dr. Nelson G. Rosen
Update Course Rewind: Patient Education and Non-Surgical Management of Pilonidal Disease 2024
With Dr. Nelson Rosen · hosted by Dr. M. Godi
Part of
Pilonidal Disease 9 items
Chapter 1 of 5 · Fundamentals
Introduction
Introduction and Session Overview
Expert statements on this page
No expert statements were drawn from this page.
Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Staging systems for pilonidal disease have been introduced previously, but not all classifications correlate with how cases are managed
Patients presenting with wounds as their initial presentation for pilonidal tend to not always get to the finish line fully healed with a minimally invasive approach
60 to 70% of pilonidal cases respond successfully to non-surgical management
Treatment decisions should be tailored to patient context, such as a 16-year-old baseball player who is miserable may proceed directly to operating room
Non-surgical management allows patients to return to activities of daily living immediately, though partial healing may occur depending on disease severity
If you're not pushing hair removal and meticulous hygiene to do the best that you can, you're probably going to end up operating on some people that might not need an operation
Many patients have come from multiple hospitals full of hair with nobody clipping them in the office or mentioning hair removal
Clipping is probably the easiest and simplest approach for hair removal when a parent or active caregiver is involved
Having someone clip the area once a week is recommended
For college students living alone without caregivers, depilatory agents (Nair) are recommended as an alternative to clipping
Wax strips can be used intraoperatively during general anesthesia to remove hair from the natal cleft and buttocks area
Proper showering with a hand shower to actually put water in the affected area is important for healing
Many patients report being told they couldn't bathe, which is problematic because without washing, healing is unlikely
John Armstrong in the United States Army had a clinic where patients were shaved weekly and closely monitored, leading to dramatic improvement and a reduced need for surgery
A large percentage of patients will be healed with non-surgical measures alone
Washlets can be helpful adjuncts for patients who struggle to clean themselves after bowel movements