Pilonidal sinus

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Pilonidal sinus Classification and external resources
Two pilonidal cysts that have formed in the gluteal cleft of an adult male.
DiseasesDB	31128
eMedicine	emerg/771
MeSH	D010864

A pilonidal sinus is an infected tract under the skin, usually between the buttocks, in the natal cleft. It is usually a small cavity containing a tuft of hair and possibly can be oozing pus.

A sinus tract is a small abnormal channel (like a small tunnel) in the body. A tract typically goes from the source of infection, often deep within the body, to the skin's surface. A sinus can be developed after an abscess is cleared (by itself or by medical treatment), then one of more of the small openings (tracts) join the cavity to the skin surface. This is not always the case as some people can develop a pilonidal sinus without ever having a pilonidal abscess.

Anyone can develop a pilonidal sinus. However, it mainly affects people between the age of 16 and 30.

1 Causes
2 Treatment
3 See also
4 External links
5 References

[edit] Causes

Pilonidal means "nest of hairs". Ingrown hairs can be one of many causes of pilonidal sinus. Discussion with a number of hair stylists indicate the pilonidal sinus have occurred on arms and other areas of the body due to the burrowing of hair.

Pilonidal sinus between the buttocks could be caused by ingrown hairs. Due to increase moisture and pressure around the buttock area, ingrown hairs find it easier to burrow into the skin. Pressure around the buttocks inhibits the body to reject the hair and thus allow it to continue to burrow deeper until infection occurs.

A recent study showed that the cause of pionidal sinus is a hormonal stimulation of a special sweat gland in the buttock: (Evidence available suggests that some of the tubular glands are controlled by hormones, in rabbit all three apocrine glands are stimulated by androgen, the human apocrine glands of the axillary and pubic region are similarly under androgen control ( 1 ).

In men sexual stimulation by visual, auditory and olfactory pathways through the hypothalamus- pituitary- testicular axis act to increase sexual desire by elevating the circulating androgen level ( 2 ) which have an effect on the sex organs in particular and on the body as a whole including the sweat glands (resulting in their stimulation and increased secretion). There are special sweat glands at the buttock (Sudoreferous glands), such glands being more active in early manhood, these glands in some animals secret odoureferous substances during rutting season to attract opposite sex ( 4 ). These glands are under androgen stimulation and when the circulating androgen level is high the secretion of these glands increases, resulting in excess sweating in the buttock area. This sweat contain excess electrolytes, the composition of sweat varies greatly from person to person, time and site. The sweat is hypotonic, the most important constituents of the sweat are Na, K (positively charged),& Cl, also urea & lactose ( 1 ).

The broken hairs in the cleft will have a negative charge by friction, which will be attracted by the positively charged sweat electrolytes to dive in to the open orifice of the sweat glands to start the process of inflammation and abscess formation.

The holes or pits seen at the buttock represent distorted hair follicles and sweat gland openings that have enlarged under the continuous and prolonged stimulation effect of the high levels of circulating androgen. These enlarged hair follicles and the open mouths or pits of the sweat glands appear first, with the ingested hairs being secondary invaders that start the process of acute inflammation and on the long term prolong the disease and interfere with healing. No hair follicle have ever been found in the sinus tract, this observation provided an early clue that hair found therein was of extraneous origin ( 2 ).. The way these broken hairs seen packed in to these tiny pits can not be explained but by this electric attraction mechanism.)^[1]

[edit] Treatment

In some cases, it can be treated with antibiotics and ointment. In more severe cases, surgery is required. Surgery involves either drainage of the sinus, or complete excision.

Drainage is the preferred method of treatment; however, sinus can return even if it has been drained. The doctor lances the abscess and drains all the pus. Then the abscess is washed with saline. The wound is left open and packed by a piece of gauze, which can fall out a few days later or be changed daily. This is a small operation and can cure the problem. Forty per cent of patients have a recurrence of pilonidal disease.

Full-excision surgery is one way of removing the abscess and sinus tracts. The surgeon uses a scalpel to remove the cavity and sinus tracts. The wound can then be left open to heal, which causes new scar tissue to grow at the base of the wound which gradually fills in the cavity (this process is called granulation). Another way is to partially close the wound, which is called marsupialisation. The edges of the wound down to deeper tissues are stitched with absorbable stitches. This procedure ensures that the centre of the wound is healing as quickly as the sides.

Surgeons can also excise the sinus and repair with a reconstructive flap technique which is done under general anesthetic. This is mainly for complicated pilonidal disease, or those who have reoccuring pilonidal disease. The surgeon cuts out the infected tissue, then moves the surrounding skin to the natal cleft and stitches it. This method leaves little to no scar as it is hidden. This method also flattens the region between the buttocks, reducing the risk of recurrence. However, surgery is not needed in all cases.^[2]

[edit] See also

[edit] External links

Pilonidal.org – Pilonidal Support Alliance
Pilonidal sinus – NHS Direct Online Health Encyclopaedia
World Wide Wounds article - article by Miller and Harding on 'Pilonidal sinus disease' including citations and images.