About this article
Medically reviewed- Written by
- Dr Paul Watson
- Medically reviewed by
- Dr Han Simpson
- Published
- August 11, 2026
- Medical review date
- September 8, 2026
- Evidence searched through
- September 8, 2026
- Next review due
- September 8, 2027
- Intended audience
- General Readers & Patients
- Geographic scope
- Worldwide
- Conflicts of interest
- None declared.
- Funding
- Website Owner
- Report a correction
- Report an error or editorial concern
- Medical disclaimer
- Read the medical disclaimer
You probably didn’t start by searching for a diagnosis. You started by feeling a sore spot at the top of the buttocks after a long drive, a shift at work, or a day spent sitting too long, then you looked in the mirror and thought, “What is this?” That’s usually when pilonidal sinus pictures enter the search bar, because people want a visual match before they’re ready for an exam.
That reaction is normal. The trouble is that online photos can be helpful in one moment and misleading in the next. Some show a quiet little pit that needs only observation, while others show an infected abscess that needs prompt care, and the difference is not always obvious from a thumbnail.
I won’t show graphic clinical photos here. I will describe what the images usually show, what they don’t show, and how to use them as a guide when you’re deciding whether to watch, book a clinic visit, or seek faster help.
A Familiar Story Before the Pictures
A lot of people who search for pilonidal sinus pictures are standing in the bathroom right after a shower, leaning over to get a better look at a tender spot they can’t quite explain. They may have noticed a tiny hole, a red lump, or a stain on underwear, then spent ten minutes scrolling through images hoping one of them looks exactly like theirs.
That moment is often awkward and a little frightening. It is also the point where photos can help, because a clear image of a classic midline pit can ease some worry, while a picture of a swollen abscess can tell someone not to keep waiting. The useful part is not finding an exact match, it is noticing whether the features fit the usual pattern of pilonidal disease.
The question patients usually ask at this stage is simple. Is this normal, is this infected, or is it something else entirely?
Pilonidal disease shows up in a very specific place, and that matters for what the picture should show. The NHS describes it as a small hole or tunnel at the top of the buttock crease, between the buttocks, and notes that pressure, friction, and sitting for long periods can contribute to it NHS pilonidal sinus guidance. That is why the same condition can look like a quiet skin dimple in one photo and a painful infected swelling in another.
A good photo should help you look for the right clues. A midline opening, a tuft of hair, drainage from a small pit, and the location a short distance above the anus all matter more than how dramatic the redness looks on a screen.
If a picture makes you ask, “Is this normal, or is this infected?”, that is usually the right question to bring to a clinician.
This guide is written for that exact question. It helps you read the photo in front of you, but it also tells you when the safer move is to stop comparing pictures and get examined.
What a Pilonidal Sinus Actually Is
At its simplest, a pilonidal sinus is a small opening or short tunnel in the skin near the crease between the buttocks. In plain English, think of a tiny pore that has been pulled inward by friction and pressure, then trapped a hair shaft that the body treats like a foreign object. The result can stay quiet for a long time, or it can flare into a painful, red, draining lump.
The words people mix up
Patients often use sinus, cyst, and abscess as if they mean the same thing, and in daily conversation they often get lumped together. They’re related, but the picture changes with the stage of the disease. A sinus is the tunnel or opening, a cyst is the enclosed pocket people usually imagine when they hear the word, and an abscess is the infected, swollen, pus-filled flare.
That distinction matters because the surface picture can be very different from the underlying problem. A small dimple can hide a deeper tract, and a swollen red patch can temporarily hide the original opening. Clinical descriptions place the classic lesion as a midline opening in the natal cleft about 5 cm from the anus, or as a 3 to 5 mm opening near the posterior midline at the sacrococcygeal level.
Who the pictures usually show
This is not a vague, rare skin issue. Widely cited adult incidence estimates are about 26 per 100,000 people, and StatPearls reports roughly 70,000 affected people annually in the United States (StatPearls overview). The condition is much more common in young men than in older adults, which is why so many reference photos feature teenagers or people in their twenties.
Practical rule: if the lesion sits in the midline cleft and the age group fits, pilonidal disease moves much higher on the list.
The point of learning this anatomy first is simple. Once you know where the disease lives and what it tends to do, the photos stop being random skin closeups and start becoming patterns you can read.
The Four Pictures You Will Most Often See
Most photo galleries collapse pilonidal disease into one blurry idea, but in clinic I usually see four visual patterns. If you can sort a picture into one of these buckets, you’re already closer to understanding what’s going on.
1. The quiet midline pit
This is the version people often miss. The picture shows a tiny 3 to 5 mm dimple or opening near the sacrococcygeal midline, sometimes with a dark speck or hair fragment at the center. The patient may feel nothing at all, or only a little itch or soreness after sitting.
What the photo does not show is the depth of the tract or whether the pit has been there long enough to matter. A quiet pit can look almost innocent, but it’s still the classic anatomic clue that makes pilonidal disease likely.
2. The early abscess
This picture usually looks angrier. There’s a red, tender, swollen lump just beside the midline, and the original pit may be hard to see because the swelling has taken over the image. The patient usually says it hurts to sit, to bend, or to lie on that side.
The camera can’t tell you how deep the infection is. It also can’t tell you whether the redness is limited to the surface or spreading outward, so a painful red lump is a better reason for exam than for more internet comparison.
3. The chronically draining sinus
This is the picture with one or more openings, often with a visible midline pit and a little wetness on the skin. The drainage may be blood-tinged, cloudy, or pus-tinged, and the surrounding skin can look irritated but not necessarily dramatic.
What the picture doesn’t show is the back-and-forth history behind it. Some of these cases drain, close, then reopen, which is why people search images over and over, trying to decide whether they’re looking at healing or persistence.
4. Recurrent or complex disease
This is the one that tends to worry patients most. The surface may show multiple openings, scars from prior procedures, and distorted skin around the cleft. Sometimes there are secondary tracts that don’t look impressive on the outside but make surgery harder.
The image still won’t show the full track map. It won’t tell you if there are deeper branches, and it won’t prove whether the anus is involved, which is one reason imaging sometimes enters the conversation.
| Visual Stage | Typical Surface Features | What the Patient Feels | What the Photo Does Not Show |
|---|---|---|---|
| Quiet midline pit | Small midline dimple, tiny dark dot, little or no redness | Often nothing, or mild soreness | Depth, tract length, hidden debris |
| Early abscess | Red, swollen, tender lump beside the midline | Pain with sitting, bending, or pressure | How deep the infection goes, spread beyond the skin |
| Chronic draining sinus | One or more openings, wetness, blood- or pus-tinged discharge | Recurrent drainage, irritation, odor | Full tract extent, branch points, deeper inflammation |
| Recurrent or complex disease | Multiple openings, scars, distorted cleft | Ongoing symptoms, repeated flare-ups | Whether secondary tracts or nearby structures are involved |
How Pilonidal Pictures Differ From Look Alikes
The hardest part of looking at pilonidal sinus pictures is not spotting the classic case. It’s deciding whether the photo belongs to pilonidal disease at all. The most useful clues are still location, the presence of a midline pit, and whether the problem shows up in other body folds.
The common mimics
A perianal abscess sits closer to the anus and usually looks like a more uniform swelling, often without the telltale midline pit. A fistula-in-ano may show an opening near the anus, but its connection is to the anal canal rather than the sacrococcygeal midline.
Hidradenitis suppurativa behaves differently again. It tends to show up as multiple lumps in groin folds, under the arms, or in other skin creases, often with scarring and paired openings. An epidermoid or pilar cyst is usually a round, well-defined lump, often off-midline, without the small central pit that makes pilonidal disease more likely.
Radiology reference material also reminds us that the usual lesion is in the posterior natal cleft, but rare extra-sacrococcygeal cases have been reported, including at unusual sites such as the cheek. That’s why a good photo should always be read with location in mind, not just shape.
The cues that actually change probability
- Distance from the anus: closer to the anus raises concern for perianal disease or a fistula.
- Midline pit: a central pit strongly supports pilonidal disease.
- Hair tufting or debris: visible hair in the opening fits the diagnosis well.
- Other body folds: lumps in the armpits or groin point more toward hidradenitis.
See also the related photo guide to sores on the buttocks, which can help when the problem isn’t quite classic.
A photo can raise suspicion, but it can’t settle anatomy. If the opening is near the anus, the picture stops being a simple internet diagnosis game.
The biggest mistake I see is assuming every sore crease lesion is pilonidal disease. The better habit is to ask, “Does the photo show a midline pit in the natal cleft, or does it look like something else?” That one question often changes the whole conversation.
What Healing Pictures Look Like Over Time
Healing photos are where patients get the most reassurance and the most confusion. A wound can look raw, wet, and still be healing normally, or it can look nearly closed and still need attention if the pattern changes the wrong way.
The early look
Right after drainage or excision, the photo often shows a raw red or pink wound bed. Mild serous drainage and a little old blood can be normal, especially if the wound is healing open from the bottom up. That look is not the same as thick pus.
The middle look
As healing progresses, the edges shrink inward and the center often looks more beefy red or pale red as granulation tissue fills in. New skin creeps in from the sides, drainage settles, and the wound looks less dramatic than it did a week earlier. That quieter appearance is usually a good sign.
The late look
Later on, the photo may show a flat pale scar or a shallow cleft with a few small dimples. Those dimples can be part of normal remodeling, not proof that the disease is back. The thing that worries me is when the area was improving and then starts opening again.
Watch the trend, not just the snapshot. A healing photo tells a different story when you line up week 1, week 3, and week 6 side by side.
The most useful picture sequence is one taken over time, not a single dramatic shot. Recent photo galleries from treatment practices often show week-by-week changes after minimally invasive and open procedures, and that’s exactly what patients need in real life, because the wound can evolve faster than a memory does.
The red flags are straightforward. Spreading redness, foul or creamy discharge, fever, a new opening away from the original site, or wound breakdown after improvement are all reasons to call the clinic instead of waiting for the next picture to reassure you.
When Imaging Goes Beyond the Photograph
A surface photo tells you what the skin looks like. It doesn’t always tell you how far the disease reaches underneath, and that’s where MRI becomes useful in selected cases.
What MRI is looking for
On MRI, pilonidal disease shows high T2/STIR signal in the midline or paramedian natal cleft. It may appear as a rounded or ovoid cyst-like lesion, a tubular tract of at least 30 mm, or an irregular abscess with surrounding cellulitis. Those details matter because the scan maps extent, inflammation, and any branching before surgery.
A comparative study found MRI had 86% sensitivity and 100% specificity for distinguishing pilonidal sinus disease from fistula-in-ano in complex cases, mainly because pilonidal disease lacked intersphincteric sepsis and enteric communication. That’s a mouthful, but the practical meaning is simple. When the anatomy is unclear, the scan helps the surgeon avoid treating the wrong problem.
When imaging is genuinely useful
- Recurrent disease: repeated drainage, repeated openings, or prior surgery with new symptoms.
- Atypical location: anything off the usual midline cleft pattern.
- Complex symptoms: multiple pits, scarring, or suspicion of deeper branching.
- Diagnostic confusion: when the photo could fit pilonidal disease, fistula, or another perianal condition.
When a careful exam is often enough
- Classic midline pit: small, simple, and not actively infected.
- Straightforward abscess: obvious tender swelling in the usual location.
- Typical drainage pattern: when the history and examination line up neatly.
Imaging is not a badge of seriousness. It’s a tool for the cases where the photo stops answering the surgeon’s real question, which is how much disease is there and where does it run?
Using These Pictures Without Misusing Them
The safest way to use pilonidal sinus pictures is as a decision aid, not as a self-diagnosis contest. The point is to match what you see with the question you are asking, whether that is, “is this normal?”, “is this infected?”, or “is this healing or coming back?”
A simple read on what you’re seeing
A single midline pit with no pain and no drainage can often be watched for a while, especially if the surrounding skin is quiet. The key clue is that it sits in the cleft and does not look inflamed.
A tender red lump, with or without pus, fits an abscess pattern and should be seen in clinic the same week. That is the part that worries me most, because the skin can look only mildly angry while the pocket underneath is already active.
Persistent or recurrent drainage from an opening near the midline usually points toward ongoing sinus disease, and a surgical opinion makes sense. Photos taken over several weeks can help show whether the opening is closing, staying the same, or reopening after brief improvement.
Pain, swelling, or drainage near the anus, or multiple lumps in the groin or armpits, should not be compared endlessly with pilonidal photos. Those findings belong in a proper examination, because the location changes the diagnosis.
A rapidly expanding red area or wound breakdown after a period of healing needs prompt medical review. That kind of change can mean the process has shifted, and waiting for the next picture is not the right move.
How to take a useful photo for a clinician
Use good lighting, ideally daylight or a bright bathroom light, so the midline pits and the surrounding redness are easy to see. One close shot and one wider shot usually tell more than a single cropped image.
A scale marker helps. A ruler or coin beside the area gives a better sense of size, and the surrounding skin should stay in frame so the clinician can judge distance from the anus, the width of the red zone, and whether there is more than one opening.
A clean photo can save time in clinic, especially when the problem comes and goes. The most helpful image is the one taken now, not a perfect example from the internet, because the current state is what guides treatment.
If you are still unsure after looking at photos, book a visit with a clinician and bring your own pictures if you have them. That conversation can sort out whether simple observation, drainage, or surgical referral makes the most sense. For further reading on evidence-based medical literature, open-access directories such as Free Medical Journals can help you find broader clinical sources without paywall barriers.