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

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

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.

Educational content only. Always verify information and use clinical judgement.