Pilonidal Sinus Disease : Causes, Risk Factors, Symptoms, Treatment, Complications, Prevention, Prognosis

A pilonidal sinus disease is the development of a small tunnel or hole in the skin, which can contain pus or fluid and ultimately result in formation of abscess or a cyst.⁽¹⁾

Pilonidal sinus disease develops at the top of the buttocks in its cleft and contains dirt, hair and other such debris.⁽²⁾ It can also become infected and cause acute pain. When a pilonidal sinus becomes infected, it oozes blood and pus with a foul odor.

The exact cause of pilonidal sinus disease is not clear, but is thought to occur as a result of hormonal changes; friction from clothes, sitting for prolonged periods of time and hair growth.⁽³⁾

Activities which cause friction, such as sitting causes the hair growth in the cleft of the buttocks to dig back beneath the skin. This is then considered as a foreign substance by the body triggering an immune response and resulting in formation of cyst, infection and pain. There can also be more than one pilonidal sinuses, which join beneath the skin.

Men and young adults are more commonly affected by pilonidal sinus disease.^{(1, 2)} This condition also affects those who sit a lot, such as taxi drivers.⁽²⁾

Initially the patient may not have any obvious symptoms of pilonidal sinus disease except for a tiny depression resembling a dimple on the skin. When infection develops in this depression, it forms a cyst filled with fluid or becomes an abscess with inflammation, swelling and pus.

Common Signs of an Infected Pilonidal Sinus are:

• Pain when standing or sitting.
• Tenderness, swelling and redness around the affected region.
• Draining of blood or pus with a foul odor.
• There is also hair coming out of the pilonidal sinus.
• Less commonly there can be low grade fever also.
• There can also be development of multiple holes or sinus tracts under the skin.

Some of the complications of pilonidal sinus are infection of the wound and recurrence even after the surgery is done. Signs of infection of the wound are:

• Acute pain with swelling and inflammation in the area of the wound.
• A fever 100.4°F or more.
• Foul odor emitting from the wound with oozing of blood and pus.

Conservative Treatment: In the initial stages of pilonidal sinus disease when there is less pain and no indications of inflammation; a broad-spectrum antibiotic is commonly prescribed. This will give relief from pain or discomfort and treat the infecting present. A follow-up exam is needed and patient is advised on keeping the area clean and shaving that area to get rid of hair on a regular basis.

Lancing is a procedure in which the abscess is incised to drain the pus and hence give relief from symptoms. A local anesthetic is given first and a sterilized scalpel is used to incise the abscess, which is then cleaned of any debris, such as hair, pus and blood.  A sterile dressing is placed on the area to allow healing of pilonidal sinus disease, which usually occurs in a month. Additional treatment for pilonidal sinus disease is not often needed.

Phenol injection is a type of treatment for pilonidal sinus disease where phenol (used as an antiseptic) is injected directly into the cyst.⁽⁴⁾ This needs to be done multiple times on different occasions, which will eventually cause these lesions to become hard and close on their own. A local anesthetic is given before the phenol is injected.

Note: It is important to know that treating the pilonidal sinus with a phenol injection has a high recurrence rate.

Surgery is needed in case of recurring pilonidal sinus or if there are many pilonidal sinus tracts. After a local anesthetic is given, the surgeon will incise all the cysts and clean them of all the debris and pus. The sinuses are stitched closed after they are cleaned. Dressings are done and need to be changed on a regular basis after the surgery, and shaving that area is recommended to prevent hair growth into the wound.

It is important to avoid prolonged hours of sitting in the same position and one should get up and move around every hour. To prevent the recurrence of pilonidal sinus disease, it is also important to clean the region of the development of pilonidal sinus disease daily and keeping it completely dry.

The outlook is very good of a pilonidal sinus, as with the right treatment, it heals within a month or two.

References:

Also Read:

• Pilonidal Cyst or Pilonidal Abscess: Causes, Risk Factors, Symptoms, Treatment, Prevention
• 6 Home Remedies to Get Rid of Pilonidal Cyst or Pilonidal Abscess
• Pilonidal Cyst or Pilonidal Abscess – Picture