ASCRS Ch16 — Pilonidal Disease and Hidradenitis Suppurativa

Citation: Bhama AR, Davis BR. "Pilonidal Disease and Hidradenitis Suppurativa." In: Steele SR, et al. (eds.), The ASCRS Textbook of Colon and Rectal Surgery, 4th ed. Springer Nature Switzerland AG;

2022. pp. 293–310 (PDF pp. 300–317 of the combined textbook file). Source file: raw/ASCRS Textbook 4th Ed.pdf (full 1,198-page textbook; cite by page range within the single PDF). Sixth chapter of Part II ("Anorectal Disease").

Type: Specialty textbook chapter (reference/background, not primary literature).

Scope

Sixteenth chapter of the sequential full-textbook ingest (see ASCRS Ch01 - Anatomy and Embryology for the ingest's scope/plan). Covers two distinct suppurative skin conditions of the perineal/natal-cleft region in one chapter: pilonidal disease (epidemiology/etiology, diagnosis, nonsurgical treatment — hygiene/hair removal, phenol, fibrin glue — surgical treatment — I&D, lay open vs. primary closure, complex flap surgery — Karydakis, Limberg/rhomboid, cleft lift/Bascom — minimally invasive treatment — VAAPS, laser ablation, trephination — management of recurrent disease, wound healing adjuncts) and hidradenitis suppurativa (epidemiology/pathogenesis, clinical presentation/diagnosis, severity classification — Hurley, Sartorius, HiSCR — treatment — topical, systemic antibiotics, biologics incl. adalimumab/infliximab and biologics-as-surgical-adjunct data, other medical therapies, laser therapies, surgery — deroofing, STEEP, wide local excision, with detailed comparative recurrence-rate data).

Key content

Filed as two new condition pages — Pilonidal Disease and Hidradenitis Suppurativa — following this wiki's established split rule (chapter covers two genuinely distinct, separately-clinically-coded entities, like Ch12 fissure/stenosis and Ch13 abscess/fistula). Cross-link added to Anal Stenosis, which had already named "hidradenitis" in its suppurative-causes differential without a dedicated page to point to — now closed, pointing to both new pages (the chapter's own diagnostic discussion notes absence of midline pits as a key HS-vs-pilonidal differentiator, and absence of anal canal involvement as a key HS-vs-Crohn's/anal-fistula differentiator).

Limitations

• Textbook chapter, not primary literature; cited trial/series data (Karydakis/Limberg/cleft-lift flap outcomes, adalimumab/infliximab RCTs, Nd:YAG laser trial, biologics-plus-surgery cohort data) are the chapter authors' synthesis, not independently re-verified.
• Both conditions' literature is explicitly noted by the chapter as heterogeneous and lacking head-to-head technique comparison — no formal classification system exists for pilonidal disease, and Hurley staging for HS has known limitations (static, not responsive to inflammatory-component change, poorly suited to multifocal disease).
• Pilonidal disease's underlying etiology (congenital vs. acquired) remains genuinely unresolved per the chapter — presented as the leading-hypothesis "acquired" model rather than settled fact.

Relevance

Sixteenth entry in the ASCRS ingest. Adds two new condition pages, closing out Part II's suppurative- skin-disease coverage. Chapter 17 continues Part II with "Dermatology and Pruritus Ani."