Adolescent Gluteal Cleft Pathologies Not Due to Pilonidal Disease: A Case Series and Diagnostic Algorithm.

Background: Problems of the gluteal cleft are often due to pilonidal disease, but at times need to be distinguished from other diseases. We reported a series of adolescent patients with non-pilonidal gluteal cleft pathologies. Methods: We performed a retrospective review of all patients who presented to our pediatric Pilonidal Clinic from 1/2019 to 12/2023. Patients who received a work-up for diseases separate from pilonidal disease were included in our study. Patient demographics, clinical work-up, and treatment outcomes were recorded. Results: We identified 21 patients who had diagnoses other than pilonidal disease: 4 patients had neurological diseases (schwannoma, central disk protrusion, arachnoid cyst, Tarlov cyst); 7 patients had dermatological diseases (folliculitis, moisture-associated skin damage); 5 patients had inflammatory bowel disease; 4 patients had sacral dimples; and 1 patient had a sacral pressure ulcer. Diagnostic decisions were based on the presence and location of an open wound, history of immobility, presence of gluteal cleft swelling or pit, clinical symptoms of pain or erythema, and other similar lesions on the body. These characteristics were utilized to differentiate the diagnoses and construct a diagnostic algorithm. Conclusions: We developed a practical diagnostic algorithm for differentiating gluteal cleft pathologies in adolescents, including dermatologic, colorectal, neurologic, and traumatic causes.