Pilonidal disease

Question 1

What is it?

Answer 1

An acquired disease in which hair follicles become inserted into the skin, creating a chronic sinus tract, usually in the natal cleft

shed or sheared hairs penetrating the skin and inciting and inflammatory reaction

Sinuses may be multiple and communicate via a deep cavity. Chronic discharge usually occurs. Infection may supervene and lead to an abscess - pilonidal abscess.

Question 2

What are the risk factors?

Answer 2

Hirsutism and stiff hair

Male

FHx pilonidal disease

Unsure about below;
Spending a long time sitting down
Occupational (e.g. hairdressers may develop interdigital pilonidal sinus)

Question 3

Presenting symptoms?

Answer 3

Painful natal cleft

Discharging swelling - sacrococcygeal

Often recurrent

skin maceration (softening n breakdown in area)

Question 4

Signs on examination?

Answer 4

openings/sinuses in the natal cleft (midline)

Hairs may protrude from the swelling

If infection or abscess, the swelling will become tender

It may be fluctuant and discharge pus or blood-stained fluid on compression. in this case also;
- fever

Question 5

investigations?

Answer 5

clinical diagnosis.

can do bloods to check infection;
wcc

Question 6

Management?

Answer 6

non symptomatic;
hair removal and good hygeine - laser

symptomatic no abscess;
surgical treatment - incision + primary closure
hair removal - laser
Abx - co-amoxiclav

symptomatic + abscess;
surgical incision and drainage
Abx - co-amox
Pain relief - nsaid or paracetamol

recurrent no abscess
incision or excision.
as above