In 1830, Herbert Mayo could never have imagined that his description of a hair-containing sinus would be the subject of debates into the 21st century. This seemingly minor disease process has physicians baffled, as demonstrated by the multiple theories of its etiology and management found in the current literature. As the name suggests, pilonidal disease consists of a hair-containing sinus or abscess in the sacrococcygeal area.
Presentations range from asymptomatic pits in the intergluteal region, to painful draining lesions.
Pilonidal disease has a male predominance and usually affects patients from the mid-teens into the thirties. Congenital and acquired theories of etiology have been proposed. It hospitalized over 80,000 US army soldiers during WWII, accounting for 4.2 million sick days. Much of the information we have about the disease comes from the military. Congenital theories dominate the first 70 years of literature.