Pilonidal Care Program

Pilonidal patients

• Please ensure that your child is bathing (shower or bathtub soak) twice a day if possible. This will help the healing process for your pilonidal disease so at your first visit we are able to initiate treatment.
• If your child is hirsute, you may shave their gluteal crease to decrease the likelihood of hair entering pilonidal pits or wounds in their gluteal crease. Do not shave two weeks prior to your visit with us.

Hidradenitis suppurativa patients

• Please shave prior to your visit. Once you have had a few laser treatments, we may ask you not to shave prior to your visit to determine how many more treatments are needed.
• If you are using topical Tretinoin cream, please discontinue use three weeks prior to your visit with us. You may resume afterwards.

• We cannot perform a laser treatment if you are currently on the medication Accutane.

• Please plan to arrive at least 15 minutes early for your first appointment. You will see us at our Waltham location on the second floor. There is a free parking garage at this location.
• You will fill out paperwork regarding your child’s pilonidal disease as well as information regarding past medical history, current medications, and allergies.

Your child's exam

Once you are called into the exam room, you will be seen by a PA or physician who will go over our clinic and treatment plan options and answer any of your questions/concerns. We will then do a physical examination of the area and discuss if we are able to perform a laser hair removal treatment and/or complete a pit picking procedure. We are able to perform these in Waltham at your first visit if we decide it is the best treatment plan and you wish to proceed.

• You will likely be asked to follow up with us in six to eight weeks. You can schedule an appointment by calling 617-919-6279.

Please do not hesitate to ask our staff for assistance or information at any stage of the process. You can also reach the medical team via email for non-urgent questions. We do not recommend email in case of urgent issues.

What to do if your pilonidal comes back

• If you have pain or a painful bump: try showering or soaking twice a day for 20-30 minutes each time to see if it will drain on its own.
• If it is not draining and you are in a lot of pain, please call either your health care provider or the General Surgery Clinic at Boston Children's Hospital at 617-919-6279 for assistance. You might need to see your health care provider or go to Boston Children's Hospital to be checked and to maybe have it drained.
• If it is draining, please keep showering or soaking twice a day to keep the area clean and to prevent hair from entering into any tiny holes or wounds in your gluteal crease. That should make the pain settle down. Call our office at 617-919-6279 to schedule an appointment in the Pilonidal Care Clinic in Waltham if you don’t already have an appointment scheduled.
• If you get a fever please call your health care provider right away.
• If you do not have pain or a painful bump, but have new drainage in your gluteal crease, try showering or soaking twice a day for 20-30 minutes each time to see if it stops. Call our office at 617-919-6279 to schedule an appointment in the Pilonidal Care Program in Waltham if you don’t already have an appointment scheduled.
• It’s normal after a pit picking to feel little lumps in your gluteal crease and to have some pain at first while sitting on a hard chair or doing floor exercises like sit ups and crunches. This usually gets better over the next few weeks and should go away.

What to do if you cannot remove the stitches after a pit picking procedure

• Remove the stitches 10 days after the pit picking. It’s harder to remove them if you leave them in longer.
• Loop on the left. To remove the stitches there is a stitch loop in the left cheek. Put just the tip of one blade of the scissors under the loop and cut the loop. Once the loop is cut, grab the knot on the right cheek with a tweezers and pull on it. The stitch will slide out. If it does not slide out easily do not pull hard, instead check to make sure the loop is cut. If there is more than one stitch, cut all of the loops first, then pull out the knots.
• If you can’t see the stitches, it is unlikely that they are gone. They are blue and are probably still there, but may be hidden, usually because of swelling and how hard it is to relax and allow the stitches to be removed.
• Try soaking in a bathtub or shower for 20 to 30 minutes or wiping the left buttocks with a wet wash cloth to see if you can then visualize the stitches. It is likely the skin began to grow over the stitches, hiding them from view. It is normal for there to be some irritation in the skin around the stitch, and maybe even a dot of blood and a small hole in the skin.
• Many people reflexively squeeze their cheeks together without even realizing, making it hard to remove the stitches. If it’s hard for them to relax, have them intentionally squeeze their cheeks together, then intentionally relax their cheeks. Remove the stitch when they’ve relaxed. It may take a few "relaxes" to get it done.
• It’s normal for the pit wounds to be red and raw, and even seem open, when the stitches come out. This usually settles down over the next few weeks and doesn’t mean it didn’t work.
• While we would be happy to see you at Boston Children’s Hospital to remove the stitches, it may be easier for you to contact your health care provider to have them remove the stitches if it’s not working out.