Pilonidal Sinus

Dermatogical Conditions
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This is an acute on chronic recurring abscess affecting the lower part of the back just at beginning of the buttock cleft. Prevalence of pilonidal disease is higher in the males than in females with a ratio of 3:1, between the ages of 15 and 40 years with the peak incidence between 16 and 20 years.

NR - Pilonidal Sinus is an acute on chronic recurring abscess affecting the lower part of the back just at beginning of the buttock cleft
Pilonidal Sinus is an acute on chronic recurring abscess affecting the lower part of the back just at beginning of the buttock clef

It is an infection of the natal cleft hair follicles. The follicle becomes distended and obstructed, finally to rupturing into the surrounding tissue to form a pilonidal abscess. Hairs from the surrounding skin are sucked into the abscess cavity by the movement of muscles while walking. Historically this affects the professions involved in prolonged periods of sitting such as  driving and computer workers but can affect any one.

Anatomy of the skin and its relation to the development of a Pilonidal Cyst
Anatomy of the skin and its relation to the development of a Pilonidal Cyst

Clinical Features of Pilonidal Sinus & Abscess:

  • Small midline pits or abscesses on or off the midline at lower sacrum
  • Large painful swelling at the same site
  • Small opening with smelly discharge
  • Rarely if ignored patient may present with sepsis

 

Treatment of Pilonidal Sinus & Abscess:

The best treatment is surgery with a success rate of 90%. Surgery can be carried out under local anaesthesia if the Pilonidal sinus is small, but mostly operations are performed under general anaesthetic. Surgery can be an excision of the sinus or simply drainage of the abscess. Mostly the sinus is excised and the wound is left open and heals within a week to 10 days. Good hygiene and keeping the lower back free of hair help to avoid recurrence which happens in about 10% of cases.