What is pilonidal sinus disease?

Pilonidal sinus disease is a tract or cavity of the natal cleft (between buttocks) that is characterised by repeated infection and chronic inflammation. It is a small hole or tunnel in the skin at the top of the buttocks crease. It can cause severe pain and discomfort together with a smelly discharge. It is caused by hair becoming embedded in the skin crevices and causing an infection. The condition is more common in young hairy Caucasian men who are high BMI and usually occurs between puberty and the age of 40.

What are the symptoms of pilonidal sinus disease?

The symptoms of pilonidal sinus include a small dimple in the skin, irritation or discomfort, painful mass which may be an abscess, drainage from the area which may be pus or blood accompanied by a foul odour and hair protruding from the lesion. There could be more than one sinus tract or hole in the skin.

How is it diagnosed?

Pilonidal sinus is usually diagnosed by physical examination of the affected area. The doctor may also ask about the patient’s symptoms and medical history. In some cases, imaging tests such as an ultrasound or MRI may be ordered to help confirm the diagnosis in more complex situations, especially to differentiate from an anal fistula.

How is pilonidal sinus disease treated?

There are several surgical procedures available to treat pilonidal sinus disease when they are at the stage of a chronically discharging recurrent sinus.

Minimally invasive procedures like Endoscopic Pilonidal Sinus Treatment (EPSiT) have the advantage of early recovery, minimal pain, and early return to work. EPSiTs do not involve excising tissues and as such three will be no more scars than what the patient already has and can be repeated if fails. This is done as a day procedure under general anaesthesia. EPSiTs carry a healing rate around 70%.

There are several excisional operations. Some involve simple closure of the wound, and some involve local flaps. Commonest flap procedures are Bascom’s and Karydarkis’. Plastic surgical flaps are reserved for more complex wounds.

In extreme situations, rarely, the wound will have to be left open to heal from inside with granulation tissue.

In more acute settings, when patients present with pilonidal abscess, they need incision and drainage with antibiotics to counter the acute infection.

It is often advised to keep the area hair free to avoid a recurrence, however, its usefulness is questionable.