Pilonidal Sinus

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A pilonidal sinus (PNS) is a small hole or tunnel in the skin. It may fill with fluid or pus, causing the formation of a cyst or abscess. It occurs in the cleft at the top of the buttocks. A pilonidal cyst usually contains hair, dirt, and debris. It can cause severe pain and can often become infected. If it becomes infected, it may ooze pus and blood and have a foul odour.

The exact cause of this condition isn’t known, but its cause is believed to be a combination of changing hormones, hair growth, and friction from clothes or from spending a long time sitting.

Activities that cause friction, like sitting, can force the hair growing in the area to burrow back under the skin. The body considers this hair foreign and launches an immune response against it, similar to how it would react when dealing with a splinter. This immune response forms the cyst around your hair. Sometimes a person may have multiple sinuses that connect under the skin.

You may not have any noticeable symptoms at first other than a small, dimple-like depression on the surface of your skin. However, once the depression becomes infected, it will quickly develop into a cyst (a closed sac filled with fluid) or an abscess (a swollen and inflamed tissue where pus collects).

The signs of an infection include:

  • 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 odor
  • Hair protruding from the lesion
  • Formation of more than one sinus tract, or
  • Holes in the skin
  • You may also experience a low-grade fever, but this is much less common

Conservative treatment

If your case is diagnosed early on, you aren’t experiencing severe pain, and there’s no sign of inflammation, it’s likely that your doctor will prescribe a broad-spectrum antibiotic. A broad-spectrum antibiotic is an antibiotic that treats a wide range of bacteria. It’s important to realize that this won’t heal the sinus tract, but it will give you relief from the infection and discomfort. Your doctor will recommend that you get a follow-up exam, regularly remove hair or shave the site, and pay particular attention to hygiene.

Surgical Treatment

  • Excision : Simple excision of the tracts and allowing healing by primary or secondary intention. Healing takes 4 to 8 weeks.
  • Excision and Skin Flaps : Excision followed by skin flaps eg Limberg Flap Or Boscom Flap Or Karydakis Flap. Healing takes 4 to 6 weeks
  • LASER Treatment: The sinus mouths are excised. Tissue and hair scooped form the tunnel. LASER energy is used to burn the tracks. Healing takes 2-3 weeks.