What criteria should I use to decide whether to refer a patient with recurrent pilonidal sinus disease to a specialist?

Criteria for referral of a patient with recurrent pilonidal sinus disease to a specialist:

• Refer patients with recurrent pilonidal sinus disease if they have persistent or recurrent symptoms despite initial management in primary care.
• Consider referral if the disease is complicated by abscess formation, extensive sinus tracts, or significant impact on quality of life.
• Referral is appropriate when surgical intervention is being considered, as specialist assessment is required to determine the most suitable surgical approach.
• Urgent referral should be made if there are signs suggestive of malignancy or atypical features, although this is rare.

These criteria align with general principles of managing recurrent or complicated conditions that do not respond to conservative treatment and require specialist input for advanced management options.