The Management of Pilonidal Sinus Disease

Abstract

Pilonidal sinus disease was first described in the nineteenth century [1]. Although a minor condition for most patients, it can result in pain and sepsis with long periods off work and education. It has caused severe disruption to the armed forces over the years. In one army center in the USA in the 1990s, over a 2-year period, 229 patients required 4,760 occupied-bed days, an average of 21 days per patient [2]. It is an acquired condition and is seldom seen before puberty. It is rarely seen in older patients. Risk factors include young age, male gender, hairiness, obesity, deep natal cleft, and poor hygiene [3, 4]. Pilonidal sinus disease is commoner in people from Mediterranean countries. It is thought to be caused by tethering of the midline raphe in the natal cleft to the underlying sacrum. Enlargement of hair follicles or skin crypts occurs resulting in sinuses, possibly as a result of changes to these follicles during puberty with blockage and subsequent sepsis within the follicles. Hair enters these sinuses and secondarily exacerbating the infection. This is facilitated by the movement of the buttocks and the barbed nature of the hairs [5, 6]. Although pilonidal pits occur elsewhere in the body due to direct puncture of the skin due to hairs, it is not thought to be the etiology in pilonidal sinus disease in the natal cleft [7].