These lesions lack an epithelial cyst wall and therefore are more appropriately indentified as a pilonidal sinus. They arise as an acquired lesion wherein hairs, trapped in folded areas of tissue, forcibly penetrate the skin and create a foreign body inflammatory reaction.
Pilonidal sinus is most commonly located in the sacrococcygeal area in men but locations in other sites such as the axillae, web spaces of the hands, and genitalia have been reported.
It appears that only about a dozen cases have reported to have involved the vulva and penis. Most of the vulvar cases have been located in periclitoral site where they may develop into a clitoral or periclitoral abscess. In uncircumcised men, penile lesions have been located in the coronal sulcus.
Pilonidal sinus first develops as an asymptomatic, soft, skin colored nodule that becomes red and very painful when as inflammation ensues. Hairs can sometimes be seen extruding from the surface of the lesion when the folds of skin around the lesion are separated. Accumulated pus within the lesion may drain from the sinus tract. Treatment is more difficult than might be expected. All of the inflamed tissue and the entire sinus tract must be completely excised. Even with careful, extensive surgery, the recurrence rate is fairly high.
Pathophysiology of pilonidal sinus
Pilonidal cysts are granulomatous reactions to small nests of hair in the midline sacrococcygeal area that progress into abscesses and tracts of infection.
Pilonidal disease is most likely an acquired disease, although a congenital origin has been argued. The disease develops from penetration of the skin by hair. An inflammatory, granulomatous reaction of pilosebaceous glands and hair follicles results in a granulomatous cyst.
Epithelialized sinuses from entrapped hairs that accumulate in the original tract and start a foreign body reaction, Bacteria may enter the sterile follicle and produce inflammation and edema, as well as occluding the follicle. The contents may expand until the follicle ruptures and the infection extends into the subcutaneous tissue, leading to abscess formation. Ninety percent of the tracts extend cephalad from the inciting follicle; they may track to the midline or laterally.
Risk factors of pilonidal sinus
- Men more than women
- Family history of pilonidal disease
- Sedentary lifestyle (lack of exercise)
- Repeated trauma (injury) to the tailbone area.
- Work that requires a lot of sitting
- Activities such as biking or motorcycle riding that can cause sweating and friction to the tailbone area.
- Heavy growth of body hair.
Patient presentation with pilonidal sinus
- Sinus tract or “pit” sacrococcygeal region
- Tenderness to palpation
- Back pain
- purulent discharge
- localized or extensive cellulitis
Diagnosis of pilonidal sinus
The diagnosis of pilonidal diseases is made by finding a painful, fluctuant area in the presacral region. Chronic or recurrent disease is appreciated when there is recurrence after incision and drainage for a pilonidal abscess has been performed.
Management of pilonidal sinus
Pilonidal abscesses may be treated with incision and drainage in the emergency department (ED). The wound should be packed, and the patient should receive follow up with a surgeon for definitive treatment.
Until recently, definitive therapy for pilonidal abscesses was an open excision that required weeks to months to heal. Simple incision and curettage, with minimal tissue loss, is now a more common surgical option.
Additional definitive options include injection with phenol, marsupialization, excision and primary closure, and excision with plastic closure. Patients may be instructed to shave the hairs within 3 to 4 cm of the cyst every 1 to 3 weeks to prevent recurrence.
Homeopathic treatment of pilonidal cyst – Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat pilonidal cyst but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to cure pilonidal cyst that can be selected on the basis of cause, sensations and modalities of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of pilonidal cyst:
Calcaria Carb, Baryta Carb, Silicea, Graphites, Hepar Sulph, Conium Mac, Nitric Acid, kali Iod, Benzoic Acid, kali Carb, Agaricus, Sabina, Sulphur, Thuja.
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