Disease Index

Pilonidal Sinus (Pilonidal cyst)

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. The diagnosis of pilonidal diseases is made by finding a painful, fluctuant area in the presacral region. The disease develops from penetration of the skin by hair.

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

  • Obesity
  • 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
  • fluctuance
  • warmth
  • purulent discharge
  • localized or extensive cellulitis
  • fever

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.


Libby Edwards, Peter J. Lynch, Sallie M. Neil, M. D. (CON) – Genital Dermatology Atlas 2010 -208

Michael l. Greenberg- Greenberg’s text-atlas of emergency medicine 2005-419

H. Winter Griffith, Stephen Moore, KENNETH YODER- Complete Guide to Symptoms, illness & Surgery 2006-512

Teresa M. Campo, Keith A Lafferty- Essential Procedures for Practitioners in Emergency, Urgent, and Primary 2010 -147


About the author

Dr. Manisha Bhatia

M.D. (Hom), CICH (Greece)
Dr. (Mrs) Manisha Bhatia is a leading homeopathy doctor working in Jaipur, India. She has studied with Prof. George Vithoulkas at the International Academy of Classical Homeopathy. She is the Director of Asha Homeopathy Medical Center, Jaipur's leading clinic for homeopathy treatment and has been practicing since 2004.

She writes for Hpathy.com about homeopathic medicines and their therapeutic indications and homeopathy treatment in various diseases. She is also Associate Professor, HoD and PG Guide at S.K. Homeopathy Medical College. To consult her online, - visit Dr. Bhatia's website.


  • There are different symptoms that may show along with a sinus infection or sinusitis. Individuals complain about pounding pressure in the head, hearing loss, stuffiness, post nasal drip, a scratchy throat and some cases of dizziness. But what really causes these symptoms?

  • Just go and visit a qualified surgeon or dermatologist. Dont fool around with various treatments.

  • i have pilonidal sinus from 20 years.now i am taking homeopathy medicine by dr.pratik banerjee of kolkata.now i want to know that homeopathy can cure it

  • i am also suffering from pilonidal sinus approx 1 and half year please suggest us what is the good treatment,surgery or homeopathy medicine (i am already take surgery but not success problem is again occured so please suggest me)….

  • i have been suffering from pilonidal sinus from since 1998, i have operator two time but did not cure permanently, now i am taking homeopathic medicine but did not cure,
    please suggested me best homeopathic medicine formula, there fore, i will be cure permanently,
    i will be awaiting for your reply thanks a lots!

  • Sir, my wife have pilonidal sinus from 1 week and delivery a boy 1 month.please advice oparation r which treatment

  • Hi doctor I am suffering from pilodinal sinus. before 8 months ago I undergone through surgery. At that time it had become OK but now it again start. So please tell me permanent solution. Presently it is not doing pain neither blood or puss is comming. But I am afraid it may be dangerous in future. During first time I gone aurvadik they use kshar sutra but there was cutting not healing of wound so they remove it by operation. At that time it had becomes OK.
    So please tell me permanent solution.

  • Any homeopath , who has treated successfully pilonidial case with homeopathy. Should Answer to all quary asked by many on this subject.

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