Treating pilonidal sinus
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Clinical presentation
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The most common presentation in the clinical setting is a swollen, usually painful lesion in the sacral area close to the anus (4–5cm away).
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Patients will typically present with an abscess and clinical signs including local warmth, redness, local pain and tenderness, and possible
induration (increase in fibrous tissue). Hair may be seen projecting from the site of the sinus.
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What is a pilonidal sinus?
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A ‘channel’ or sinus which develops in the natal cleft
between the buttocks and behind the anus.
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It commonly
involves a hair, which has pierced the
skin causing a tiny cyst; or the distension of a hair
follicle, which then becomes blocked.
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can develop, leading to a wound if left untreated.
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When the sinus requires surgery, the condition can
result in a painful wound that may take months to
fully heal.
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What causes a pilonidal sinus?
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Pilonidal sinuses have two main causes:
Congenital:
where the patient is predisposed due to a ‘dimpling’ of the
natal cleft, meaning hair and debris such as dead skin cells can collect
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Acquired:
a result of in-growing hairs, which lead to the hair follicle
becoming swollen with keratin and infected due to the accumulation of
hair, cellular debris and bacteria. This can lead to can lead to rupture of
the follicle and infection.
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They can also be caused by ‘stretching’ and ‘pulling’ in the deeper levels
of tissue in the natal cleft, causing disruption and eventual rupture of
the hair follicle.
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Presentation is more common in males than females and is often seen in
younger people due to hormonal changes affecting the skin.
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Signs/symptoms
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Complications
Prevention
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Pain at the wound site
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Swelling
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Discharge of pus or blood
from the wound
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Inflammation
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General malaise
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Pyrexia (fever).
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Infection
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Haemorrhage at the wound site
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Delayed healing
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Wound breakdown
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Wound recurrence
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Psychological issues, particularly
embrassment and stigma due to
the positioning of the wound and
associations with poor hygiene.
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The natal cleft requires special
attention with regards cleaning
and should be kept as free from
hair as possible
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Weekly shaving or the use of a
hair removal cream up to the
age of 30 is recommended to
prevent recurrence.
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