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### What you need to know A 25 year old man who works as a driver of heavy goods vehicles complains of pain and swelling in the natal cleft over the past few months. On examination, inflammation is evident in the sacrococcygeal region, with visible pits and discharging sinuses. Sacrococcygeal pilonidal disease is an inflammatory condition of the skin and subcutaneous tissues of the natal cleft, often presenting as a spectrum ranging from asymptomatic pits to painful large abscesses. The term “pilonidal” is derived from the Latin “nest of hairs,” referencing the accepted pathophysiology of loose hair burrowing into normal skin, and causing a foreign body reaction. Sacrococcygeal pilonidal disease primarily affects young adults of working age. Patients usually have few comorbidities. In this article, we outline approaches to assessment of sacrococcygeal pilonidal disease, alleviation of symptoms, and guidance on referral. Sacrococcygeal pilonidal disease can arise in one of

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