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Intergluteal pilonidal disease: Clinical manifestations and diagnosis

Daniel J Sullivan, MD, MPH
David C Brooks, MD
Elizabeth Breen, MD
Section Editor
Russell S Berman, MD
Deputy Editor
Wenliang Chen, MD, PhD


Intergluteal pilonidal disease is an infection of the skin and subcutaneous tissue at or near the upper part of the natal cleft of the buttocks. Pilonidal cavities are not true cysts and lack a fully epithelialized lining; however, the sinus tracts may be epithelialized (figure 1) [1]. While the presence of a pilonidal cavity may be asymptomatic [2], the disease typically presents as either an acute or a chronic process [3].


The natal cleft, also called the intergluteal cleft, is the groove between the buttocks that extends from just below the sacrum to the perineum, superior to the anus (figure 2). The cleft or sulcus occurs as a result of the anchoring of the deep layers of the skin overlying the coccyx to the anococcygeal raphe. The cleft forms the border between the gluteus maximus muscles, which obscure the cleft when a person is upright.


The incidence of disease is approximately 26 per 100,000 population, with a mean age at presentation of 19 years for women and 21 years for men, and men are affected two to four times more often than women [1,4,5]. Pilonidal disease is infrequently encountered in children and adults older than 45 years. Patient presentations are equivalently divided between acute and chronic disease; few patients present with asymptomatic disease [3].

Risk factors for pilonidal disease include [1,2,5]:

  • Overweight/obesity
  • Local trauma or irritation
  • Sedentary lifestyle or prolonged sitting
  • Deep natal cleft
  • Family history


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Literature review current through: Sep 2016. | This topic last updated: Mar 4, 2015.
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