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20 Jan 2017

Pilonidal Disease


A chronic benign ano-rectal problem of cyst at the crease of the buttock pilonidal disease is an inflamed infected dimpled hair pit. A pilonidal sinus (PNS) is a lumpy growth with debris and hair near the tailbone (coccyx) and commonly witnessed more among men than in women, occurring mostly at onset of puberty and rare after the age of 40. Male to female ratio of PNS occurrence is 3:1, the sex hormones change during puberty, aggravating the pilosebaceous glands secretion. People with PNS develop one or more cysts in the form of a dimple and hair sticking out of it at the cleft of the butt. The cyst might be infected after a while, pus and blood oozing out of it with foul smell, accompanied by severe pain and discomfort.

Pilus in latin means hair and nidus, a nest, thus derived the term pilonidal, a condition wherein the hair follicle is infected at the natal cleft. The hair invading the skin at the natal cleft acts as a foreign body, which result in the formation of pus-filled cavity in the hair follicle. The natal cleft is a seat for the disease and leads to infected hair follicles that in turn cause edema, obstructing the follicular passage at the skin. PNS may arise either as an abscess, sinus tract or in a more complex format of recurring abscess with proliferating branches of sinus tract.

Causes :

There is no particular cause of the disease but mostly believed to arise due to a combined effect of changing hormones during puberty. Excessive oil secretion of sebaceous glands at the base of the skin around the hairs near sacrococcygeal region, stimulating the hair, and friction from clothes or extremely sedentary habit increases the likelihood of developing abscess around the hairs. Continuous long hours of sitting force the hair shafts to draw back into the pit of the butt area during which the body treats the hair as a foreign splinter and launch immune attack, forming a cyst encircling the hair; the hair sticking out of the cyst. Obesity and deeper cleft are other predisposing factors that increase the risk of PNS. In certain rare cases, congenital PNS cysts have also been reported.

Symptoms :

Some of the following signs are clear indication that an abnormality of the skin lesion near tailbone is PNS:

  • Dimple like depressed appearance
  • Pain and discomfort while seated or in standing position
  • Swollen cyst
  • Inflamed red and swollen skin around the dimpled pit
  • Pus and blood deposition along with foul odour in the infected portion
  • Hair protrusion from a lesion
  • Holes near the skin of the natal cleft or sinus tracts formed
  • Fever in severe cases

Treatment :

PNS disease is diagnosed through physical examination of the rear portion. Doctor might not suggest any specific treatment unless the cyst is infected, in which case the pus is drained out followed by an anti-biotic course. The healing period is long, almost 4-5 weeks. In case of recurrence of infection, the cyst is diagnosed with more than one opening or if the cyst does not heal even after removal of fluid substance, the cyst is surgically excised. Often, surgical removal is the only assured way to avert reappearance of abscess and ascertain complete clearance of the infection from the root of hair follicles.

In order to avoid developing PNS or recurrence, as a proactive measure, the area must be kept dry and clean using alcohol or medicated soap. Soaking in warm water and avoid sitting or standing for long durations at a stretch are some more preventive methods.

Koya Stopiles™ Clinic in Hyderabad, and now in Bangalore, is a specialized clinic with expertise to deal with ano-rectal problems. The team of doctors have years of experience in diagnosis and treatment of ano-rectal problems, seeking monitored help from experts overseas. The techniques are US-FDA approved and minimally invasive in treatment of haemorrhoids, fistulas and fissures. Pilonidal cysts also could be cured effectively seeking clinical intervention at the facility with utmost precision and care.




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