This form of the disease is usually asymptomatic, that is, it usually does not hurt. Many patients report only discomfort when sitting.

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These small holes are called pilonidal sinuses, as they communicate the skin with the cyst without necessarily forming a fistula.

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*Photo of a patient with asymptomatic multifistulizing disease

When the external orifice of the cyst is occluded or local trauma occurs, infection of the cyst may occur, leading to abscess formation. 

If something like this is happening to you, look for an emergency room service with a surgeon.

After an infection of the cyst (abscess), the site of the pus leak may generate a path, which communicates the skin with the cyst. 

This type of disease presentation usually occurs in patients who take a long time to seek help to treat, leading to complications such as multiple abscesses and multiple drainage points.

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Due to the distinct characteristic of the disease, one must be confident with the diagnosis, as confusion with anorectal fistulas and hidradenitis suppurativa (different diseases) can occur.

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One of the most striking features of pilonidal disease is its chance of recurrence (that is, it can come back), there are basically two causes:

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.The disease has recurred (a new cyst has formed)

.The cyst was not completely resected in the first surgery.

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Photo of a patient who had already undergone 2 surgeries, in which the video-assisted technique was chosen, and it was observed that the cyst was about 3 cm from the previous incisions.