A pilonidal sinus is a dilation of the hair follicles in the gluteal cleft. This causes the hair to grow upside down and fill a cyst with hair and sections. Over time, the cyst can drain musty foul smelling fluid. If the cyst does not drain, it may fill with fluid leading to swelling or eventually become infected and become an abscess. The abscess can be anywhere from the anus to the sacrum or even the buttocks.. It frequently contains hair, pus or blood,and can also have a foul odor once it starts oozing. The pilonidal cyst can cause pain and be an acute problem or it may be a recurrent issue which may need a more aggressive surgical management. This is a common condition with more than 70,000 cases reported in the U.S. each year.
It is believed to be caused by change of hormones, hair growth and friction from tight clothing and from sitting for long periods. It is when loose hairs grow into the wrong direction forcing hair back under the skin. The body will then launch an immune response to it causing inflammation Sometimes they can form multiple sinuses that connects under the skin. Multiple “pits” or holes can be seen in the midline buttock cleft.
- Young adult white male, between puberty and age 40
- Populations with increased body hair
- Inactive lifestyle
- Sitting for long periods
- Having stiff/thick body hair
- Broad-spectrum antibiotics – not to heal the sinus tract but for relief of infection or discomfort
- Regularly remove hair via laser, electrolysis or shave the site and pay particular attention to hygiene
- Incision and drainage by a wound surgeon followed by Antibacterial wound dressing/packing
- Surgical excision of the sinuses and cysts
Excision of the pilonidal cyst requires cutting out the tissue containing the abnormal cells. The tract or infection can extend from the skin to the sacral bone. Additionally, the sinuses can interconnect to one central cyst. After the tissue is excised, it is important to avoid sitting for at least 2 weeks. Any tension on the incision can lead to dehiscence or the incision separation. This occurs in approximately 50% of the pilonidal excision wounds. If it opens, and occasionally because the Wound cannot be closed, the wound will need to be packed for a prolonged period of 6-12 weeks.