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Pilonidal Sinus is one of the skin conditions and is mostly seen in men. This problem, called pilonidal sinus in medicine, can also lead to inflammation. It can occur in many parts of the body. However, we can say that it usually occurs in the coccyx region. It can also be seen in the face, groin, armpit and finger area.
Studies show that pilonidal Sinus is more common in men between the ages of 15 and 35. This problem can be prevented by paying attention to hygiene conditions and regularly removing unwanted hair from the body. However, if it cannot be prevented, medical intervention is required. We will explain the symptoms and treatment of pilonidal Sinus. Let’s consider the reasons beforehand.
What Causes Pilonidal Sinus?
In fact, it was first seen in the American soldiers returning from Vietnam. In the researches on this, it was seen that the soldiers’ sitting for a long time and the lack of hygiene were the biggest factors.
In general, we can say that the problem of pilonidal sinus is caused by 2 different problems. The first of these is entering of the hairs falling from the body through the pores in the skin. These hairs accumulate under the skin and as a result, this problem occurs. It is known that around 60 to 79 hairs can enter under the skin during body movements. With entering of the bristles under the skin, it is surrounded by a membrane and creates a cystic structure. The fluid formed as a result of the cystic structure can flow out of the sinus mouth. We can say that this liquid has a bad odor.
There is another theory that causes pilonidal sinus. This is the activation of the innate stem cells in the area where the problem occurs. Especially after the 20s, stem cells are activated with the effect of hormones. After that, hair production starts and this leads to pilonidal sinus. However, we can state that this second theory is less accepted than the first. It is difficult to say precisely that the source of the problem has been determined.
We can also talk about some risk factors in this regard. One of the most important risk factors is to lead a sedentary life. For this reason, the problem is observed more frequently in desk workers. However, we can list other risk factors as follows:
- Obesity
- Not paying attention to hygiene conditions
- Removing unwanted hair with a blade
- Excessive sweating problem
- Excessive hair on the body
- Genetic predisposition
- Sedentary lifestyle
- Work at a desk job
What are the symptoms of Pilonidal Sinus?
When patients have ingrown hair problems, they often do not immediately understand it. We can state that this problem is progressing very insidiously. Some symptoms may occur only when hairs accumulate under the skin. These symptoms do not bother patients in the first place. Therefore, we cannot state that it is taken very seriously. Patients start to feel discomfort only in the period progressing and the need to consult a doctor arises.
We can give a short list of common symptoms:
- Flix in the area where the ingrown hair has occurred
- Inflammation that is white or green in color
- The flix has a foul odor
- Some people have bloody flix
- Mild or severe pain
- Redness, swelling in the area where the ingrown hair has occurred
The reason for the bad smell is usually inflammation in this area over time. Especially with the growth of microbes in the area of inflammation, the color of the inflammation begins to turn green. With the cystic structure turning into abscess, pain occurs. Most of the patients need to consult a doctor at this stage. The pain is sometimes extremely severe and patients may even find it difficult to do their daily activities.
How Is Inflamed Pilonidal Sinus Treated?
It is thought that the problem of ingrown hair, which is often inflamed, is treated with very different methods. However, we can state that there are no big differences in the treatment procedure. Surgical intervention is also required to eliminate the problem of ingrown hair that is inflamed. By applying a small incision to the skin, this area is cleaned and the intervention is terminated. In such cases, we can state that there is a short recovery period. Generally, the patient relaxes after this procedure, but over time, 90% of the patients recur after the abscess is evacuated. As a result, patients undergo surgery.
Pilonidal Sinus Surgery
First of all, we can say that the most effective way in the problem of ingrown hair is surgical intervention. In case of surgery, this problem is much less likely to relapse. Since an extremely small incision is applied to the skin during the operation, there is no need to worry about a large scar. In surgery, an incision is applied to the skin. Afterwards, this area is thoroughly cleaned. Then, the incision area is stitched and the process is completed. Of course, the operation is performed under general or spinal anesthesia. Therefore, the patient does not experience pain or pain during the procedure. In a sense, we can say that the surgery is completed with a very comfortable process.
Sinusectomy
Surgery is sometimes performed under local anesthesia. The sinusectomy technique, which does not require the patient to be hospitalized in the clinical environment, has become one of the most preferred methods in recent years. In this method, it can be said that there is almost no scar on the patient’s body. At the same time, the time for the patient to return to daily life is much shorter. There is a shorter and easier recovery period. The duration of the operation is usually between 20 minutes and 30 minutes. This period is prolonged only in cases such as when the inflammation has spread over a wide area. In such cases, the operation time may be extended up to 1 hour. Before the operation, you can get a clearer information about the operation time from your doctor.
Rhomboid Flap
The area of ingrown hair is removed in the form of a diamond slice, the same size incision is made and the empty space is filled. A drain is placed, and it is removed after about 3 days. Stitches are usually removed on the 15th day. The relapse rate is around 5%.
Karydakis Flap
It is an operation found by a Greek colleague. Although the flap method is the same, there are fewer scars in terms of scarring, but recurrence rates are high.
Open Surgery
In this surgery, the area with ingrown hair is removed and left for dressing, and this surgery has a high relapse rate. It is very bad for the comfort of the patient if the dressings last at least one month.
Will Pilonidal Sinus Relapse?
Of course, it cannot be used to say that the ingrown hair will never recur after treatment. Unfortunately, there is a risk of this problem developing again after treatment. However, it should not be overlooked that much more advanced techniques are used today. Thanks to these advanced techniques, the possibility of recurrence of ingrown hair is almost negligible. Although there is a risk of recurrence, it is possible to state that the probability is quite low. However, patients also have some duties. Matters such as maximum attention to hygiene conditions should be given importance.
After Pilonidal Sinus Surgery
Of course, some issues need to be paid attention to after pilonidal sinus operation. The healing process may not be the same in every patient. We can say that the recovery period generally takes between 6 and 8 weeks. However, in some operations, only 2 weeks to 3 weeks may be sufficient for the completion of the recovery. After the operation, attention should be paid to home hygiene and care for the intervened area.
If there are medications prescribed by the doctor, we should state that their regular use is also of great importance. Care should be taken not to sweat the area where the intervention is made and this area must be kept clean. Cleaning the hair in this area with ideal methods can also reduce the possibility of recurrence of ingrown hair. Depending on the surgery, some temporary vital changes may be required, such as the preference of sitting high on the toilet. Considering the doctor’s suggestions and warnings will ensure a smooth healing process.
Pilonidal Sinus Antibiotic Therapy
Antibiotic treatment can help regress the ingrown hair problem. In ingrown hair, the patient may not be disturbed for a long time, when there is inflammation in the area of ingrown hair, only antibiotics do not help. We recommend using antibiotics after cleansing that inflamed area. However, in progressive cases, surgical intervention is required. When you apply to the doctor, it can be determined what kind of treatment will be applied with a simple examination. Then, detailed information is transferred to the patient. You can consult your doctor about treatment methods and the recovery process after treatment. You can immediately write all your questions on the subject in the comment section.
How to Recognize Pilonidal Sinus?
Generally, hemorrhoid is a disease that is confused with many anal area diseases such as anal fissure or anal fistula. The reason for this is that the anal area is not visible to the eye and people do not consult a doctor until the event progresses because they are embarrassed. It should be suspicious that there is pain 2-3 cm above the anus, which we usually call the sacrum, and when you look at that area, you can see small holes and hair growth from these holes.
Is there any non-surgical treatment for Pilonidal Sinus?
Phenol Treatment
Phenol treatment is applied in small new hair growths, the hair area is cleaned and phenol in crystal form is poured into it. This event continues until the wound is closed.
Laser Therapy
The sinus area is cleaned, the special probe of the laser device is placed inside and that area is burned.
It is not preferred in our country due to its high financial aspect.
Degrees of plonidal sinus
Grade 0
Grade 1
The bristles have entered from the sinus, not below 1 cm, and the bristle holes are still in the midline. It happens at a time of 6 months.
Grade 2
The hair sinuses have passed under 1 cm and small inflammations have started to occur from time to time. It happens in 6 months to 1 year.
Grade 3
Fistulas reached 6 cm and the number of holes increased in the midline, 3 cm spread to the side area.
Patients are disturbed with continuous abscesses, the duration is 1 to 5 years.
Grade 4
Fistulas are over 7 cm and in places necrosis areas are detected. There is a continuous discharge in the patient. Duration is 5-15 years.
