Treatment of Chronic Pilonidal Disease with a Chronic Draining Sinus

Clinical Scenario

This protocol addresses patients with chronic pilonidal disease presenting with a chronic draining sinus in the intergluteal fold, in the absence of an acute abscess. This is the typical picture of long-standing, low-grade disease that has not acutely flared but continues to drain.

Treatment Approach

Management focuses on achieving complete removal of hair and debris from the sinus tract. Options include the use of fibrin glue — applied alone or combined with a surgical approach — as well as surgical excision techniques. The choice of method and the full step-by-step treatment algorithm are detailed in the structured protocol.

Full regimen details, sequencing, and procedural specifics available via the link below.

Treatment Goal

Resolution of the chronic low-grade inflammation through complete hair and debris removal.

Instant Access to Structured Evidence-Based Regimens

References

Patients with chronic disease will most often present with chronic draining sinus disease in the intergluteal fold.

Those with chronic disease, but without an abscess, can be treated with fibrin glue alone or in conjunction with surgical excision to prevent recurrence.

Excision and primary closure or healing by secondary intention, including marsupialization, are primary therapy options for chronic pilonidal disease with sinuses.

Despite a lack of high-quality evidence for the best nonoperative approach, the main goal of any method is to achieve complete hair and debris removal to resolve the chronic low-grade inflammation.

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