There is a silent medical epidemic unfolding in exam rooms, urgent care clinics, and operating theaters across the world—one that leaves teenagers and young adults suffering for months, sometimes years, often subjected to the wrong procedures again and again. Few have heard of this condition. Even fewer physicians know how to treat it effectively.

It’s called pilonidal disease, and it’s far more common than most realize.

Misunderstood, Mismanaged, and Mistaken

Pilonidal disease is an infection of the gluteal cleft—the area between the buttocks—where deep skin folds and friction can cause hair and bacteria to burrow under the skin. It’s an acquired infection, not a congenital cyst, primarily affecting otherwise healthy adolescents and young adults. It’s estimated that 1–3% of young people in the United States develop this condition. While it doesn’t threaten life, it can deeply disrupt it.

In 1944, during World War II, nearly 80,000 soldiers were hospitalized with pilonidal infections, so many that it was dubbed “Jeep Disease” due to the jarring rides in military vehicles. Even then, surgeons struggled to treat it effectively. Now, nearly a century later, we still do.

Stories from the Front Lines

Nathan, a 19-year-old college sophomore from Texas, came to my clinic after four failed surgeries. He’d been treated with repeated incisions, long-term wound packing, and eventually a massive excisional surgery that left him bedridden for months. “I just want to sit in class without pain,” he told me. By then, he’d missed nearly a year of school.

Maria, a 15-year-old aspiring dancer from Los Angeles, was told her pain was “just a cyst” and underwent a series of drainage procedures.  She eventually was convinced to have an operation.  Her wound was closed in the midline and became infected a week later.  She was left with several draining wounds.  The surgeon wanted to reoperate and perform the same procedure.  She began to look online for another solution. By the time she found us, she’d given up dancing altogether.

These stories aren’t rare. They are the norm.

Where Surgery Goes Wrong

Early, “acute” pilonidal abscesses are often treated with small, slit-like incisions and packing. The intent is to “drain the infection,” but the outcome is frequently the opposite. The incision is often too small to allow adequate drainage, and the gauze acts more like a cork than a wick, trapping pus and prolonging infection. Patients often repeat this cycle for months.

When the disease becomes “chronic,” many are referred for more aggressive operations. These typically involve wide excisions down the centerline of the buttocks. These wounds often require months to heal and must be packed daily, creating both physical and emotional distress. Worse, recurrence rates can range from 30% to over 50%, according to multiple surgical studies.

In these cases, patients aren’t just suffering from an infection—they’re suffering from medical mismanagement.

The Surgery That Actually Works

There is a solution. It’s called the Cleft-Lift, also known as the Pilonidal RAF (Rotation and Advancement Flap) Procedure. This outpatient operation reshapes the cleft to reduce friction, eliminates infected tissue and dead space, and moves the scar off the midline to a location that heals more reliably.

In my last 1,300 consecutive cases, the reoperation rate is less than 1%. That’s not a marginal improvement—it’s a curative approach in a field long defined by frustration and failure.

So why don’t more surgeons offer it?

Because most aren’t trained to. Pilonidal disease is often treated as an afterthought in medical school curricula and residency training. Many textbooks still describe it incorrectly as a congenital cyst. And few academic institutions teach the Pilonidal RAF/Cleft-Lift Procedure, simply because most surgical educators have never performed it themselves.

The Cost of Failure

It’s estimated that over 100,000 pilonidal operations are performed each year in the U.S., many of them wide excisions that leave patients with long recoveries and a high risk of recurrence. Each failed procedure costs money, time, and productivity, often leading to additional surgeries, home nursing care, and time off school or work.

But the greatest cost is invisible: the emotional toll of being a young person living in shame, in pain, and in isolation. Some of my patients have missed their proms, dropped out of sports, or developed depression after years of failed treatment.

And yet, this disease still flies under the radar.

We Don’t Need Innovation—We Need Education

Pilonidal disease doesn’t require a miracle cure. It doesn’t require AI, robotic surgery, or new pharmaceuticals. It requires that we update our understanding and perform the right procedure from the start.

• Medical schools must teach that this is an acquired infection, not a congenital anomaly.
• Surgical societies should certify proficiency in the Pilonidal RAF/Cleft-Lift Procedure.
• Insurers should recognize the cost savings in avoiding repeat procedures.
• And, surgeons should be held to higher standards of informed consent—patients deserve to know there’s a better option than the one they’re being offered.

Patients Deserve Better

It’s not unusual for a patient to arrive at my clinic after having seen five or six different providers, undergone multiple operations, and suffered for years. What’s unusual is how quickly they improve once they receive the right surgery. Most are healed within a few weeks, with no wound packing, no home nursing, and no need for additional procedures.

The difference isn’t in the complexity of the disease. It’s in the choice of surgical approach.

We must stop treating pilonidal disease as a minor annoyance or surgical afterthought. It’s time to recognize it as what it is: a common, curable condition that the medical establishment has catastrophically misunderstood for decades.

Let’s change that!

If you would like to learn more about the approach at The Sternberg Clinic, please contact us or submit the information requested on the ‘Become a Patient’ page of our website.