Pilonidal sinus disease is a chronic inflammatory condition that consists of cycles of healing and wound breakdown often for many years. It is predominantly found in young males. Clinical presentation can be of an acute abscess formation or a non-healing wound in the natal cleft. The latter, chronic version of the disease significantly impacts on an individual’s quality of life due to the extended need for ongoing wound care and recurrent wound infection. There is great variation in the treatment options in the chronic form of the disease such as surgical intervention and subsequent healing by secondary intention or flap formation, with the off-midline surgical closure method is recommended for the prevention of recurrence. This article gives an overview of the condition.