Clin Med: Common Office Dermatology

Benign melanocyte Nevi (mole)

Noncancerous proliferations of melanocytes that are typically symmetric, uniformly pigmented and well circumscribed with smooth borders; usually less than 6 mm; may mature over time from Junctional → Compound → Intradermal; normal to change with pregnancy (darker and slight enlargement) and older adults (fading but more in common)

junctional nevi

type of melanocyte nevi that appears flat and uniformly brown; found in epidermis

compound nevi

type of melanocyte nevi that appears raised and pigmented; found in dermoepidermal junction

intradermal nevi

type of melanocyte nevi that appears dome shaped and flesh colored; can have terminal hairs; found in dermis

Atypical (Dysplastic) Nevi

Acquired melanocytic moles that have irregular clinical and histologic features; have ABCD and may be flat, raised, or both; Markers of increased melanoma risk (esp if a lot or family history of melanoma but most do not progress)

Management:

• Not routine excised but may be biopsied if concerning features/documented change

• Refer to derm if uncertain diagnosis, melanoma cannot be excluded, &/or pt has many present or a strong personal/family history of melanoma;

• Encourage monthly skin self-examinations, prompt evaluation of any new or changing lesions by provider, and push for sun protection (Over 30 SPF, protective clothing, shade, avoid tanning and excessive UV exposure)

Freckles (Ephelides)

common benign pigmented lesion of flat, brown macules (usually <3 mm); common in children and fair-skinned individuals; increase with sun exposure and fade in winter; become less noticeable with age; treatment is sun protection

Solar Lentigines

common benign tan to dark brown macules with well-defined borders; common in middle-aged to older adults; caused by chronic cumulative UV exposure; persist year-round, increase in number with age; “age spots” or “liver spots”

Treatment: Sun protection, cosmetic treatments (retinoids, cryotherapy, laser, chemical peels) if desired

Seborrheic Keratosis

Benign proliferation of epidermal keratinocytes that are commonly acquired by older adults; look "Stuck-on," waxy, or verrucous papules and plaques that are tan, brown, or black and well-demarcated; usually 3 mm to several centimeters and are common on the trunk, face, neck, and extremities (palms and soles are spared)

Treatment: Reassurance that new lesions commonly develop with age and are benign; No treatment unless symptomatic or cosmetically bothersome (cryotherapy, curettage, or shave removal) since they can come back

Seborrheic Keratosis

"Stuck-on," waxy, or verrucous papules and plaques that are tan, brown, or black and well-demarcated; usually 3 mm to several centimeters and are common on the trunk, face, neck, and extremities (palms and soles are spared)

Treatment: Reassurance that new lesions commonly develop with age and are benign; No treatment unless symptomatic or cosmetically bothersome (cryotherapy, curettage, or shave removal) since they can come back

Dermatofibromas

Common benign fibrous skin lesion that often develops after minor trauma (e.g., insect bite or shaving)

Dermatofibromas

A firm papule or small nodule that is pink, tan, or brown and usually <1 cm; Most commonly on the lower extremities and can confirm with a positive dimple sign from lateral compression

Management: Reassurance; biopsy if diagnosis is uncertain or lesion changes; surgical excision is curative if symptomatic or desired, but may leave a scar because of deeper attachment

Lipoma

Benign, slow-growing tumor composed of mature adipose (fat) tissue that develops within the subcutaneous soft tissues

Lipoma

Soft, mobile, painless subcutaneous mass that is slow-growing and most commonly on the trunk, neck, shoulders, and proximal extremities; diagnosed clinically/by observation but can use ultrasound if uncertain or MRI for deep or atypical lesions

Management: Observation for asymptomatic lesions; surgical excision if symptomatic, enlarging, cosmetically bothersome, or diagnosis is uncertain

Pyogenic Granuloma (Lobular Capillary Hemangioma)

Benign, rapidly growing vascular lesion that often develops after minor trauma

Pyogenic Granuloma (Lobular Capillary Hemangioma)

Bright red, friable papule or nodule that bleeds easily with minimal trauma; common on the fingers, hands, face, lips, and gingiva; rapid growth over days to weeks

Management: Small lesions may regress spontaneously, but many persist or recur; shave excision with electrocautery/curettage or surgical excision if needed; biopsy if diagnosis is uncertain or malignancy cannot be excluded

Cherry Angioma

Common benign vascular proliferation of capillaries

Cherry Angioma

Bright red to violaceous dome-shaped papules that are usually 1–5 mm (may enlarge over time); Common on the trunk, arms, and shoulders and increase in number with age; Often occur as multiple lesions and may bleed significantly if traumatized

Management: No treatment is necessary; Remove only if frequently traumatized, bleeding, or cosmetically bothersome by cryotherapy, electrocautery, laser therapy, or shave excision

Café-au-lait Macules

A common pigmented birthmark with flat, uniformly light brown macules or patches present at birth or early childhood that are well-demarcated; may enlarge as the child grows; Can prompt eval for neurofibromatosis type 1 is 6+ macules that are >5 mm for prepubertal children or >15 mm after puberty

Congenital Dermal Melanocytosis

A common pigmented birthmark with blue-gray congenital macules, caused by dermal melanocytes that fail to migrate completely during embryonic development'; usually located over the lumbosacral area and buttocks and are common in infants with darker skin pigmentation; fade during early childhood in most children; can be mistaken for bruising (ensure proper documentation)

Nevus simplex

Benign congenital capillary malformation; flat, pink-red, present at birth that blanches with pressure; most commonly seen on glabella ("angel kiss"), eyelids, or nape ("stork bite"); “Salmon patch”

facial = fade within 1–2 years

nuchal = often persist into adulthood

No treatment is required and typ only need to give reassurance

Nevus Flammeus

Congenital capillary malformation present at birth seen as flat, pink-red lesion that gradually becomes dark red to violaceous and does not spontaneously regress; may darken, thicken, and become nodular over time; most commonly affects the face, but can occur anywhere; Port-Wine Stain

Treatment is with a pulsed-dye laser (best results when started early in childhood) typ only for cosmetic reasons but can reduce lesion thickening over time

Hemangioma of Infancy (Infantile Hemangioma)

Benign vascular tumor caused by proliferation of endothelial cells; bright red, raised lesion if superficial or blue-purple if deeper that is soft and compressible; usually not present at birth, but appear within the first few weeks of life and may have rapid growth during first 6-12 months; Typ just observation if uncomplicated but can give oral propranolol to shrink blood vessels and decrease growth; urgently refer to derm if it ulcerates or bleeds, interferes with vision, feeding, hearing, or airway, is rapidly enlarging, or is segmental or very large (may indicate associated syndromes); more severe cases do surgery or laser therapy but most regress by school age (tho may have residual skin changes)

Keratoacanthoma (KA)

Rapidly growing, well-differentiated variant of cutaneous squamous cell carcinoma (cSCC) that are historically considered a benign lesion because many regress spontaneously but are managed as SCC because it cannot be reliably distinguished from invasive SCC

Keratoacanthoma (KA)

A firm, dome-shaped nodule with rapid growth over weeks and a central keratin-filled crater ("volcano-like" appearance); usually 1–2 cm and most common on sun-exposed skin (face, ears, dorsal hands, forearms); manage with excisional biopsy preferrably and need histopathologic examination to exclude invasive SCC (treated as cutaneous SCC until proven otherwise)

Actinic Keratosis (AK)

Premalignant proliferation of atypical keratinocytes caused by chronic ultraviolet (UV) exposure

Actinic Keratosis (AK)

A rough, gritty ("sandpaper") papule or plaque that is “non-healing” and erythematous with adherent scale; usually found on chronically sun-exposed skin (face, scalp, ears, forearms, dorsal hands) and is thus a marker of cumulative sun damage and can progress to invasive squamous cell carcinoma; manage with cryotherapy for isolated lesions or field therapy for multiple lesions (5-fluorouracil, imiquimod, or other topical agents) and push for sun protection

5-FU, 5-fluorouracil (Adrucil)

Field therapy for multiple lesions of AK that is a topical chemotherapy medication that inhibits cells’ ability to produce DNA

Imiquimod (Aldara) cream

Field therapy for multiple lesions of AK that is a immune modifier (activates the body’s immune system to eliminate abnormal cells)

Basal Cell Carcinoma (BCC)

the most common skin cancer that arises from the basal cells of the epidermis and is slow-growing and locally invasive; metastasis is extremely rare (<0.1%); increased risk if chronic UV exposure, fair skin, light-colored eyes, red or blond hair, history of blistering sunburns, older age, immunosuppression, and/or prior ionizing radiation exposure; most commonly on chronically sun-exposed skin; low risk are surgically excised, curettage & electrodesiccation, photodynamic therapy; high-risk undergo Mohs micrographic surgery or radiation therapy if surgery is not possible; excellent prognosis with treatment but can reoccur though metastasis is very uncommon

Photodynamic therapy

a technique in which low-risk BCC is treated with a photosensitising chemical, and exposed to light several hours later.

Basal Cell Carcinoma Nodular

A pearly, translucent papule or nodule with a rolled border, surface telangiectasias, central ulceration ("rodent ulcer") may develop; non-healing sore or scab that repeatedly bleeds, crusts, and won’t heal; most common type

Basal Cell Carcinoma Superficial

A thin, pink scaly patch often found on the trunk and may resemble eczema; can treat this version only with topical Imiquimod or 5-Fluorouracil and select can undergo cyrotherapy

Basal Cell Carcinoma Pigmented

A papule with brown or black pigmentation that can mimic melanoma

Basal Cell Carcinoma Morpheaform/sclerosing

A scar-like, ill-defined lesion that is most aggressive locally

Squamous Cell Carcinoma (SCC)

the second most common skin cancer that is a malignancy of keratinocytes arising from the stratum spinosum and usually develops on chronically sun-exposed skin; can arise from actinic keratosis; more aggressive than BCC and is locally invasive; can metastasize (2–5%; higher risk on lips, ears, scars, immunosuppressed patients) so earlier diagnosis improves outcomes; increased risk from chronic UV exposure, actinic keratoses, fair skin, older age, male, immunosuppression, chronic wounds/burn scars, ionizing radiation, smoking (especially lip SCC), and HPV (genital/periungual SCC); diagnose with shave or punch biopsy

Treatment: Surgical excision, Mohs surgery (face, ears, lips, recurrent lesions), curettage & electrodessication (selected low-risk lesions), radiation if not a surgical candidate; do a full skin examination at follow-up due to higher risk of future skin cancers and push for sun protection

Squamous Cell Carcinoma (SCC)

A firm, erythematous papule, plaque, or nodule that is hyperkeratotic (thick scale) with rough, crusted surface that may ulcerate or bleed; often painful or tender and are a non-healing lesion; most common locations are the face, ears, lower lip, scalp, dorsal hands, and forearms

Intradermal Squamous Cell Carcinoma (Bowen’s Disease, SCC in situ)

Squamous cell carcinoma confined to the epidermis ("in situ") where malignant keratinocytes have not invaded the dermis; higher risk if chronic UV exposure (most common), older age, immunosuppression, arsenic exposure (rare today), HPV (especially nail unit lesions); may progress to invasive SCC; biopsy to confirm diagnosis

Intradermal Squamous Cell Carcinoma (Bowen’s Disease, SCC in situ)

Slowly enlarging, well-demarcated red scaly, or crusted patch that may resemble eczema or psoriasis and usually occurs on sun-exposed skin; periungal (nail) lesions may be associated with HPV infection

Treatment: Excision or Mohs; Cryotherapy or topical 5-FU/Imiquimod for selected lesions

Moh’s Procedure

A specialized surgical technique used to remove skin cancer one layer at a time so that each layer is immediately examined under the microscope and continues until all cancer cells are removed; gives the highest cure rate for many skin cancers while removing the least amount of normal tissue (best cosmetic outcome); Used for BCC, squamous cell, recurrent skin cancers, and tumors on the face

Malignant Melanoma (MM)

Less common skin cancer but is deadlier/most aggressive (Responsible for the majority of skin cancer deaths); from malignancy of melanocytes; early detection is highly curable (>90% 5-year survival when localized) but advanced melanoma has a much poorer prognosis; approximately 70% arise de novo (new) and 30% arise from pre-existing nevi; Risk factors are UV exposure and blistering sunburns, fair skin, light-colored eyes, blond/red hair, family or personal history of melanoma, numerous (>50) or atypical nevi, tanning bed use, and immunosuppression; utilize ABCDE checklist

Superficial spreading malignant melanoma

Most common malignant melanoma subtype with slow radial growth followed by rapid vertical invasion; common on trunk (men), legs (women); about 70% of MM cases

Nodular malignant melanoma

malignant melanoma subtype that does rapid vertical growth and has a blue-black nodule; poorer prognosis; about 15-30% of cases

Acral lentiginous malignant melanoma

malignant melanoma subtype that is found on palms, soles, nail beds; most common melanoma in darker skin

Lentigo Maligna

Melanoma in situ on chronically sun-exposed skin that is more common in those > 60 and can grow for 5-15 years before becoming invasive; most common in sun-exposed areas of the head and neck including nose and cheeks

Lentigo Maligna

Begins as an irregular tan macule that spreads peripherally and develops into shades of tan and brown; should urgently refer to dermatology; diagnose with preferably excisional biopsy but can do punch/incisional biopsy only in selected locations (large lesions, palms, soles, nail); treat with Mohs

Lentigo Malignant Melanoma

Lentigo Maligna that is diagnosed when the melanoma cells have invaded into the dermis; Treatment is wide local excision or sentinel node biopsy for appropriate lesions

TNM Staging

A tool used to describe tumor (Breslow thickness/depth of invasion through presence or absence of ulceration), nodes (spread to regional lymph nodes), and metastasis (spread to distant organs)

Kaposi Sarcoma

Vascular tumor caused by Human Herpesvirus-8 (HHV-8); most seen in patients with HIV/AIDS or other immunosuppressed states and may involve the skin, oral mucosa, GI tract, and lungs

Kaposi Sarcoma

A violaceous (purple-red), non-blanching macules, plaques, or nodules; typ see multiple and most commonly affects the lower extremities, face, and oral mucosa; diagnose with biopsy and evaluate for underlying immunosuppression (especially HIV)

Treatment: Optimize immune function (ex: antiretroviral therapy in HIV) and then give local therapy via surgical excision, intralesional chemotherapy, or radiation; if disseminated disease, it may need systemic therapy

Herpes – Types I and II

Viral infection caused by the HSV I/II virus; after initial infection, HSV remains latent in sensory ganglia and periodically reactivates by common triggers like fever, illness, stress, sun exposure, immunosuppression;

HSV-1: Most commonly causes oral herpes (can also cause genital herpes)
HSV-2: Most commonly causes genital herpes (can also cause oral herpes)

Herpes – Types I and II

Clusters of painful vesicles on an erythematous base that rupture to form shallow ulcers and then crust over; have a prodrome/early onset: burning, tingling, itching or pain that occurs 24-48 hours before vesicles appear with possible malaise and low-grade temp; treat with antivirals that are best to initiate within 1 day of lesion onset or during the prodrome phase for best results

Acyclovir OR Valacyclovir OR Famciclovir

antivirals where treatment is for 7–10 days, depending on the severity of the outbreak, and can be given in low doses for daily use

Varicella (chickenpox)

Successive crops of lesions caused by the varicella-zoster virus in different stages of development: macules → papules → vesicles → pustules → crusts; lesions can be present in ALL stages simultaneously and erupt for up to 5 days; typically begins on face/scalp and trunk and spreads outward to extremities; See fever, malaise, pruritic rash on face and trunk that moves to extremities

Treatment for health children is supportive care, antihistamines, calamine, but avoid aspirin; can give oral acyclovir can be considered if started within 24 hours in select patients (immunocompromised, chronic disease, etc); prevent with Varicella vaccine (first dose at 12-15 months, second dose at 4-6 years old)

Shingles

Reactivation of varicella zoster virus (VZV) in a sensory (dorsal root or cranial nerve) ganglion, producing a dermatomal rash

Shingles

Painful grouped vesicles on an erythematous base confined to a single dermatome (usually unilateral and almost never crosses the midline); feel burning, tingling, or pain often begins 2-5 days before the rash with painful unilateral vesicular eruption and low-grade fever and malaise may occur

Treatment: Valacyclovir, acyclovir, famciclovir (antivirals) started within 72 hours of rash onset (or while new lesions continue appearing) since earlier treatment reduces symptom duration and risk of postherpetic neuralgia; prevent with Shingrix vaccine (two doses separated by 2-6 months for adults 50 yo or older)

Human Papillomavirus (HPV)

DNA virus that infects the basal keratinocytes of the epidermis where infection stimulates excess keratin production, resulting in the development of warts; type 6 & 11 = genitial warts, type 16 & 18 = •cervical, anal, penile, vulvar, vaginal, and oropharyngeal cancers, and skin types = common, plantar, and flat warts

Human Papillomavirus (HPV)

Hyperkeratotic, rough, flesh-colored papules with a rough ("cauliflower") surface that can have tiny black dots often visible after paring; plantar warts may be painful with walking because pressure pushes them inward

Treatment is Salicylic acid, cryotherapy (liquid nitrogen), electrodessication/curettage, Imiquimod for external genital warts (but most warts regress spontaneously due to cell-mediated immune response but may take months to years)

Prevention with HPV Vaccine (Gardasil 9) protects against HPV types responsible for 90% of cervical cancers and most genital warts (not HPV types that cause common or plantar warts) and is routinly given at 11-12 years of age. (can begin at age 9)

Verruca vulgaris

common warts

Verruca plantaris

plantar warts

Verruca plana

flat warts

Condyloma acuminatum

genital warts

Molluscum Contagiosum

Benign viral skin infection caused by a poxvirus that is spread by skin-to-skin contact or even shared towels/ equipment but can do autoinoculation (scratching spreads lesions)

Molluscum Contagiosum

2-5 mm smooth, flesh colored, dome shaped papules with central umbilication (dimple), a waxy/ pearly appearance, and are not vesicles

•Treatment is typically not needed as because of self-immunity causing resolution (typically takes 6–18 months or up to 2–3 years), but if numerous, bothersome, cosmetically concerning, or immunocompromised you can do curettage, cryotherapy, cantharidin (Ycanth), berdazimer gel (Zelsuvmi)

Skin Tags (Acrochordons)

Common, benign pedunculated fibroepithelial polyps that are soft, flesh-colored to brown, pedunculated ("on a stalk"), usually 1–10 mm, and most commonly on the Neck, Axillae, Eyelids, and/or Groin/inframammary folds; are associated with obesity, Insulin resistance/type 2 diabetes (metabolic syndrome), Pregnancy, and Increasing age; No treatment needed unless symptomatic or cosmetic which then they can be removed by: Snip excision, Cryotherapy, or Electrocautery

Perioral Dermatitis

Chronic inflammatory facial eruption of papules and pustules that occurs around the mouth, nose, or eyes

Perioral Dermatitis

Multiple small erythematous papules/pustules around the mouth, nose, or eyes but spares the vermilion border of the lips; the surrounding skin may be dry and scaly but usually no comedones/blackheads (helps distinguish from acne); increased risk with use of topical corticosteroids, cosmetics/heavy moisturizers, fluorinated toothpaste, or hormonal changes

Treat first by zero therapy: avoid Cosmetics, sunscreens, emollients, AND topical corticosteroids  but if still symptomatic or if patient prefers treatment, can give a Topical metronidazole OR Topical erythromycin; If patient cannot tolerate topical or if disease is moderate to severe, can give oral doxycycline (tetracycline), oral erythromycin or azithromycin (in pregnant women or children under 8); treatment may take 4-8 weeks

Acne Vulgaris

Chronic inflammatory disease of the pilosebaceous unit (hair follicle + sebaceous gland) caused by follicular plugging, excess sebum, Cutibacterium acnes (a bacterium that colonizes the skin before puberty and can lead to inflammatory acne), and inflammation; causes open or closed comedones (A plugged follicular orifice)

Acne Vulgaris

Open comedones (blackheads) and closed comedones (whiteheads) are hallmark lesions and inflammatory papules, pustules, and nodules may be present; typically involves the face, chest, shoulders, and back; may heal with post-inflammatory hyperpigmentation and permanent scarring

Mild Cases (mostly comedones, with a few papules/pustules) are treated with Benzoyl peroxide, Topical retinoid, or topical clindamycin (with benzoyl peroxide)

Moderate cases (numerous papules and pustules with inflammatory lesions, few nodules) are treated with also oral doxycycline with topical retinoid and benzoyl peroxide

Severe cases (numerous inflammatory papules, pustules, nodules, cysts, extensive involvement, scarring) are treated with Oral Isotretinoin (Accutane) but it is teratogenic (REALLY bad for fetus) and provider needs iPLEDGE certification

Epidermal Inclusion Cyst

Benign cyst arising from the infundibulum (upper portion) of a hair follicle and filled with keratin

Epidermal Inclusion Cyst

Firm, freely movable dermal nodule with a central punctum (blackhead) that contains foul- smelling cheesy keratin if expressed; most common on the face, neck, scalp, and trunk; and may become inflamed and rupture, mimicking an abscess;

No treatment if asymptomatic, but if inflamed: Intralesional corticosteroid (triamcinolone acetonide) or incision and drainage if fluctuant; complete surgical excision with removal of cyst wall if a definitive treatment is needed

Rosacea

Chronic inflammatory disorder causing facial flushing and central facial erythema

Rosacea

Persistent central facial erythema (cheeks, nose, chin, forehead) with flushing and visible telangiectasias; could be Papules and pustules without comedones and may progress to rhinophyma (bulbous nose) in advanced disease; can have ocular involvement with dry, gritty, burning eyes with blepharitis or conjunctivitis; increased risk in adults (30-50 years) and fair skin with triggers of heat, sunlight, hot beverages, spicy foods, alcohol, exercise, emotional stress

Treat by avoiding triggers or mild cases can be given Topical metronidazole (MetroGel®), Azelaic acid (Finacea®), Topical Ivermectin (Soolantra®), or Topical clindamycin; moderate cases may use Oral doxycycline; severe cases need dermatology referral for laser therapy (persistent erythema/ telangiectasias) or surgery for rhinophyma

Alopecia Areata

Autoimmune, non-scarring hair loss caused by T-cell attack on the hair follicle

Alopecia Areata

Smooth, well-demarcated round or oval patches of hair loss with normal-appearing skin (no erythema or scaling); may involve scalp, beard, eyebrows, eyelashes, or body hair; characteristic exclamation mark hair may be observed, particularly at the periphery of bald patches; may have tingling or itching preceding hair loss (trichodynia); upon regrowth, hairs may initially lack pigment and may grow back as white or blondender trichoscopy, black or yellow dots may be seen;nails can change (pitting and ridging, Beau’s lines possible); diagnose with hair pull test, trichoscopy may help, or biopsy if uncertain

Treatment for Limited disease (<50%) is Intralesional corticosteroids (first-line), Topical corticosteroids, and Minoxidil (adjunct); for Extensive disease (>50%), give dermatology referral for Topical immunotherapy, JAK inhibitors (baricitinib), or systemic corticosteroids (selected patients)

patchy alopecia

most common type of Alopecia Areata

alopecia totalis

type of Alopecia Areata with complete scalp hair loss

type of Alopecia Areata with complete loss of all body hair

Androgenetic Alopecia (Male/Female Pattern Hair Loss)

Most common cause of hair loss that is genetically determined and androgen-mediated; for men you see a receding hairline and vertex thinning and for women you see diffuse thinning over the crown with preserved frontal hairline; treat with Topical minoxidil or Oral finasteride (men only)

Scarring (Cicatricial) Alopecia

type of alopecia with permanent hair loss due to destruction of hair follicles; Causes: trauma/burns, discoid lupus, severe infections; Hair does not regrow

Traction Alopecia

type of alopecia caused by chronic tension on hair (common with tight braids, ponytails, buns, weaves); usually affects the frontal and temporal scalp and is reversible early but prolonged traction can cause permanent scarring

Telogen Effluvium

type of alopecia with rapid hair loss 2-3 months after a physiologic stress (childbirth, surgery, severe illness, rapid weight loss, emotional stress) where hair follicles remain intact and it usually resolves over several months

Trichotillomania

Hair loss caused by recurrent pulling, twisting, or breaking of one’s own hair; often associated with anxiety, OCD, or other psychiatric disorders; see irregular patches of hair loss, broken hairs of varying lengths but scalp appears otherwise normal; eyebrows and eyelashes may also be involved; treat with cognitive behavioral therapy (habit reversal training) and underlying psychiatric condition if present (psychiatry/behavioral health referral)

Pilonidal Disease

An inflammatory condition of the natal (gluteal) cleft in which hair penetrates the skin, triggering chronic inflammation, leading to pits, sinus tracts, cysts, or abscesses; increased risk male, aged 15-30 years, obesity, deep natal cleft, excess body hair, prolonged sitting, recurrent friction/ trauma

If asymptomatic, no treatment required, if acute abscess, do incision and Drainage, if chronic/ recurrent disease, defer to general surgery for definitive excision; to prevent after healing, keep the cleft clean and dry, hair removal, weight loss if appropriate, avoid prolonged sitting

Chronic pilonidal disease

Recurrent pain and swelling, persistent or intermittent purulent or bloody drainage. Multiple sinus tracts or pits

Acute pilonidal abscess

Sudden onset of a painful, fluctuant, erythematous mass. May have fever.  Often the first presentation

Asymptomatic (may hear term pilonidal cyst)

type of pilonidal disease where midline pits may be present, no pain or drainage