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A pilonidal abscess occurs exclusively at the region of the natal and buttock clefts. The natal cleft is the ‘valley’ between the buttocks overlying the ‘tail bone’ of the spine and the buttock cleft is the corresponding ‘valley’ between the fleshy parts of the buttocks.
The patient will experience a tender and red skin lump on either side of the cleft region, and this corresponds to an abscess. Some patients may, however, experience a pimple-sized nodule with occasional discharge of small amounts of pus for weeks on end.
The pilonidal abscess has a unique underlying cause. Most pilonidal abscesses occur in individuals with heavy hair growth at the buttock and cleft regions. The pilonidal abscess starts with ingrown hairs at the depth of the ‘valley’ of the clefts that eventually form tiny hair pits. The hair pits can be identified during a specialist consult as it manifests as small pinpoint holes in the clefts. The infection then spreads from these pits to both sides of the clefts to form an abscess.