Pit-picking resolves pilonidal disease in adolescents

The purpose of the study was to evaluate the outcome of pit-picking on adolescents with pilonidal disease. Patients presenting to a Pilonidal Clinic were managed by evacuation of any un-drained collections, soaking, and as needed, hair removal. Once active inflammation resolved, they underwent pit-picking under local anesthesia. Those with >3 pits underwent sequential pit-pickings 2 months apart. Hirsute patients also underwent laser hair epilation. Pilonidal disease was stratified by severity. Patient symptoms were collected prospectively and reviewed. Fifty-eight patients underwent at least one pit-picking from February 2016 to September 2017. There were 40 (69%) males with a mean age of 17.7 years (range 13–24). Thirty-seven hirsute patients (64%) underwent a series of laser epilation treatments. Patients required from 0 to 3 days of non-narcotic analgesia, and all returned promptly to pre-procedure activities. Seven patients (12%) were lost to follow-up. Of the 51 patients with follow-up data, 47 (92%) were symptom-free an average of 5.0 months (range 1–20) post-procedure. Four patients (8%) had persistent intermittent drainage. Pit-picking is a simple office procedure that may resolve pilonidal disease in many adolescents. A longer follow-up interval is needed to determine the long-term recurrence rate. Case Series. Level IV.