Pilonidal Disease / Pilonidal Sinus / Pilonidal Cyst
The word pilonidal comes from the Latin "Nest of Hairs".
The word is apt, as hairs become embedded deep to the skin covering
the tail bone (Fig I) forming a "nest of hairs". It
is a common problem with men aged between I5 and 35 becoming
less common after that age. However, young women are also prone
to the disease.
There are many explanations for the disease. The
most easily accepted is that hairs, especially tough hairs,
find weak spots
in the skin of the crease of the buttocks and become buried
after breaking off (Fig 2). As the holes in the skin become bigger,
more and more hairs find their way to be buried under the skin,
which now has multiple openings (Fig 3). Thousands of hairs
eventually
become buried and cause an infection and abscess formation.
SYMPTOMS
The patient notices pain, a lump and a discharge of fluid in
the tail bone region. He or she may complain of moisture
with a foul smell. The condition may improve only to recur
after
some weeks or months. Often an abscess forms. This may cause
fever
and severe tenderness.
TREATMENT
Early cases can sometimes be relieved by pulling out
the hairs before they are completely buried.
The surrounding area is then shaved to prevent further hairs
from entering the openings. Usually the disease progresses beyond
this stage and masses of hairs must be removed surgically. An
incision is made to excise all the holes and then all the buried
material must be removed. This can be done in a Day Centre with
deep sedation by an anaesthetist and additional local anaesthesia
if necessary. It may be possible to re-suture the opening created,
but if the infection is severe, it is better to leave the gap
open and treat at first with daily dressings. Later, baths are
all that is required. This enables the defect to heal from its
depth. The patient can return to work within a few days. It is
important that the surrounding area is shaved regularly to prevent
recurrences.
LEGENDS
Figure 1: A line drawing showing the mid-line openings over
the tail bone. Deep to the openings shown a 'nest of hairs'
has become established.
Figure 2: Photograph showing a hair entering an opening. There
are also other hairs which entered at an earlier stage and have
not yet been completely buried.
Figure 3: The openings have become more apparent after shaving.
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