Pilonidal Disease
What is a Pilonidal Sinus?
A pilonidal sinus is a small pit or tunnel that forms in the skin near the tailbone (coccyx), at the top of the buttocks cleft. It often contains hair, debris, and dead skin cells. While a pilonidal sinus might not cause any problems initially, it can become infected and develop into a painful abscess.
Causes and Risk Factors
The exact cause of pilonidal sinus formation is unknown, but several factors can contribute to it:
- Ingrown hairs: Hair breaking off and burrowing back into the skin is a common culprit.
- Friction: Tight clothing or activities that put pressure on the tailbone area, like cycling or sitting for long periods, can irritate the skin.
- Excess body hair: People with coarse or thick hair are more prone to developing pilonidal sinus.
Symptoms of a Pilonidal Sinus
You might not experience any symptoms with a pilonidal sinus initially. However, if it gets infected, you might notice:
- Pain and tenderness in the tailbone area
- A visible pit or opening in the skin near the tailbone
- Redness, swelling, and warmth around the pit
- Pus draining from the opening
Management
The only definitive management of acute or chronic pilonidal disease is surgery
Conservative measures may include:
- Shaving or laser hair removal may be considered as first line therapy or in recurrent disease
- Weight loss
- Improve hygiene
Surgical management options for pilonidal disease:
Acute disease – Incision and drainage of abscess, removing granulation tissue, hair and debris to reduce recurrence rate. Leave pits alone. Treat with antibiotics if cellulitis is present.
Chronic / recurrent disease – Different approaches available. Decision for these approaches will be determined by the extent of disease, patient’s personal risk of infection or poor wound healing and surgeon’s expertise or preference
- Minimally invasive – pit picking (usually in conjunction with abscess drainage), endoscopic treatment
- Excision with secondary intention healing (open wound) – excision of disease but allow the wound to heal without closure. Wound care is resource intensive but it has relatively lower rate of wound infection when compared to primary closures
- Excision with primary closure – excision of disease with preference for off-midline closure as it is associated with lower recurrence rates as compared to midline closures.
- Excision with flap repair (e.g. Karydakis flap, Bascom cleft lip) – involves mobilising a flap across the midline, with excision of the skin, sinus tracts and midline pits, forming a lateralised wound.
