Pilonidal Sinus-(cyst appearance, disease, surgery, treatment)

What is a Pilonidal Sinus or cyst?

Pilonidal sinus or cyst are small holes or tunnels in the skin that easily become infected. They usually form in the cleft on the upper part of the buttocks. Hair punctures the skin, causing the cyst to become embedded. If the cyst gets infected, it can cause severe pain. It is possible to drain the cyst by making a small incision in the skin. In some cases, surgery may be necessary. Pilonidal sinus tend to recur in young adult males.

People who sit for a long time are at a higher risk of developing a pilonidal infection. It's infections are most common in men and in young adults. They are also more likely to occur in people who sit for a long time period , such as cab drivers.

First appearance of pilonidal infected cyst:

Pilonidal Abscess is an infection of the hair follicle and the accumulation of pus in the fat tissue, pus draining into a small hole in the skin , sensitivity over the affected area after exercise or prolonged siting hot, swollen, tender area around the tailbone, very rarely (high fever). It's cyst appear as a hole in the skin caused by an abscess that has been there for a long time. if it appears as a sinus a small pore like opening in the skin that has dark spots or hair, it is also comes out as a tract that grows beneath the skin or deeper than the hair follicle.

Diagnostic Patterns:

Pilonidal sinus sepsis can be either acute (as an abscess) or chronic (as an infected sinus with occasional swelling and spontaneous draining) or chronically (as a poorly draining sinus). Diagnosis is based on the site and appearance of infection. Primary pits are almost always found in the center of the midline, one of which seems to be the point of origin. Primary openings are almost always located in the middle of the midline. These pits are an important indicator of sepsis. Induration may be present with or without the presence of an abscess. Patient has a chronic sinus with recurrent swelling, abscces or drainage.

Primary openings are usually in the center and often contain infected hairs and granulation. More complex Fistulization may occur multiple primary openings and secondary openings with an elevated and slightly erythematic coloration. Unusual presentations may include multiple tract and opening simulating severe hedonic suppurativa and may extend to the perineum as well as isolated anterior and posterior sinuses. Surgical intervention can be done in left lateral or jack knife positions with optimal access to most of the pilonidal nasal passages.

Surgeries and Treatments for Pilonidal Infection Sinus:

Excision with primary closure:

Primary intention surgery involves excision and primary closure, with a drain being used to flush the operative cavity.In some patients, healing was always by first intention, with no complications and no recurrences. The drainage of blood from the bottom of the wound and the use of antiseptic/saline flushing are essential for primary intention healing.

Incision and drainage:

A small incision was made using local anesthetics to drain the cyst. Once the incision is made and the cyst is drained, you may need to insert gauze packing into the incision. If this is the case, the cyst should be removed within 1-2 days. A simple abscess does not require antibiotics unless the infection has spread to the skin surrounding the wound. The wound will heal over a period of 1-2 weeks depending on how large the cyst is.

Sclerosing injection:

This is a variation on the method used by the Cutler and Zollinger team for the injection procedure. It is non-invasive and relies on the cauterization of the sinuses caused by the fumigating action of nitric acid. A follow-up after one year shows the durability of the final outcome with this method.

Excision with skin grafting and Z-plasty:

This procedure involves the removal of the disease area, skin grafts from other parts of the body, and the graft being taken over the wound area. Most operations for this condition are performed as outpatient procedures, but in some cases, inpatient hospitalizations may be necessary for wound care and immobilization while the graft is being taken. This type of operation is also known as a flap procedure, where a flap of skin is transplanted from one part of the body to another.

This type of surgery is also called a Z-plasty, as the final scar appears to have three limbs in a Z shape. Pilonidal disease has been removed from the area, and the Z-plasty is an effort to cover up the defect. While this is not necessarily a bas thing, it has to be performed very aggressively to flatten out the glutesal cleft, and the cosmetic results are not very attractive.

Marsupialization with or without excision:

Pilonidal disease infection can be treated surgically. One of the most invasive treatments is to remove the diseased tissue all the way down to the sutures. Clipping the defect is technically difficult and must be covered by local flap procedures unless it is intended to be primary sutured or lay-open. The most widely used technique among these surgeries is Limberg flap. However, flap techniques and primary suturing can have many drawbacks, most notably recurrence of disease. For recurrent flap or primary suturing cases in pilonidal sinuses, the treatment of choice is marsupialization. 

Pilonidal disease treatment without surgical procedures:

Pilonidal sinus pain and itching can be relieved by applying a hot and wet compression to the cyst several times a day. A warm towel applied to the cyst can also help to improve blood circulation. As the blood circulation increases, the pain subsides and the healing process of the cyst improves. Applying warm compression technique for around 15 minutes a day can provide significant relief from the problems caused by the sinuses. Bathing in warm water can also be effective in relieving pain of the affected area. A sitz bath can also be used for the same purpose, can prevent cyst from getting worse. Medications and ointments can be used to treat the sinus. Allopathic, ayurvaduc and homeopathic medicines are effective in treating the sinus.

In allopathic  conditions, broad spectrum antibiotics are widely used to treat the non- suspiratory cases. So if you are diagnosed with the early stages, you may not experience any intense pain or inflammation. You may also experience mild discomfort. In such cases, doctor is likely to prescribe you some antibiotics. The most common antibiotics are ibuprofen, acetaminophen, that help in reducing swelling and pain.

Pilonidal sinus can be treated with these effective methods, but it may reappear. Consult a doctor for a permanent solution and consider modern surgical procedures, such as laser-based treatment, which is safe and minimally invasive.