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Pilonidal sinus

What is Pilonidal sinus?

Pilonidal sinus is midline opening formed by a cyst or an abscess near the tailbone that often contains hair, dirt and skin debris.

How does it occur?

It is thought that the combination of buttock friction and shearing forces in that area causes broken hairs which collect there and drill through the midline skin and enter the skin by the suction created by movement of the buttocks. The body considers this hair foreign and launches an immune response against it and this immune response forms the cyst around your hair.

What are the risk factors of Pilonidal sinus?

obesity – having a body mass index (BMI) of 30 or above

age – pilonidal sinuses can occur at any age, but are more common in young adults between the ages of 15 and 40

having an above-average amount of body hair, which may be why more men are affected than women

having coarse and curly body hair

a previous injury to the affected area of skin – for example, from a fall

having a deep cleft between your buttocks

having a family history of the condition – more than one-third of people have a family member with the condition

having a job involving a lot of driving or sitting down for long periods

What are the symptoms of Pilonidal sinus?

At first you may notice a small, dimple-like depression on the surface of your skin. However, once the depression becomes infected, it will quickly develop into a cyst or an abscess.

Signs and symptoms of infection are-

pain when sitting or standing

swelling of the cyst

reddened, sore skin around the area

pus or blood draining from the abscess, causing a foul odour

hair protruding from the lesion

formation of more than one sinus tract, or holes in the skin

How do you treat Pilonidal sinus?

Conservative treatment- In those whose symptoms are relatively minor, simple cleaning out of the tracks and removal of all hair, with regular shaving of the area and strict hygiene, may be recommended.

Incision and drainage- This is done in acute exacerbation of the disease.

Before this procedure, your doctor will give you a local anaesthetic. They will then use a scalpel to open the abscess. They will clean away any hair, blood, and pus from inside the abscess. Your doctor will pack the wound with sterile dressing and allow it to heal from the inside out. The wound usually heals within four weeks, and many patients don’t require any further treatment.

Surgery- Surgery is the treatment of choice in chronic or recurring abscesses or sinuses.

What are the surgical treatments available?

Limberg Flap- The rhomboid (Limberg) flap. The flap design places the longitudinal axis of the rhomboid excision parallel to the line of minimal skin tension

Irrespective of procedure, postoperative wound care is important and centres around elimination of hair (ingrown, local or other) from the wound.

How can you prevent the recurrence of Pilonidal sinuses?

You can prevent recurrence by washing the area on a daily basis with a mild soap, making sure all soap is removed, keeping the area completely dry, and avoiding sitting for long periods.

Shaving of hair on the back and the buttock area.

Permanent laser treatment also can be helpful.