Makindo Medical Notes

Pilonidal sinus disease is an acquired, chronic, inflammatory condition of the skin and subcutaneous tissue in the sacrococcygeal region of the body

About

• Chronic infection caused by ingrowth of hairs into a sinus in the cleft of the buttocks
• Pilonidal means a nest of hairs: pilus (hair) and nidus (nest)
• Affects 26 per 100,000 population,

Aetiology

• Trapped hair with infection
• Post puberty and hormonal changes may be relevant
• Males Age 18-30 most common group
• Dark haired hirsute people with sedentary lifestyle

Clinical

• Seen in young adults 15-30 years old
• Natal cleft usually 5 cm above anus
• Inter digital - hairdressers
• Pain, discomfort, swelling and erythema with acute abscess formation
• The tender abscess may at times discharge

Investigations

• FBC, U&E, LFTs, CRP, Glucose
• Rigid sigmoidoscopy or MRI imaging if any concerns about inner opening

Pathology

• Keratin distends hair follicle with oedema and folliculitis
• Gradually forms a deep abscess
• Rare cases can even lead to osteomyelitis

Management

• Prevention with Hygiene, clipping weight loss etc. Clipping with hair removal. Meticulous perianal hygiene with regular baths or showers. Buttock hair removal techniques, such as laser treatment, waxing, shaving, and depilatory creams (there is some evidence of a lower recurrence rate after laser hair removal compared with shaving and depilatory creams).
• Incision and drainage for any abscess with curetting to remove debris and hair cell nests and packing. May need antibiotics. Incision and drainage may sometimes be performed in primary care if the lesion is small and superficial, and the expertise and facilities are available. Otherwise, the person should be referred to a colorectal or general surgical unit according to local protocol.
• Recurrent disease may warrant Karydakis procedure or avoid by regular shaving of the area
• Complete en block resection in those with severe disease

References

• Understanding pilonidal sinus disease