Pilonidal Sinus/Abscess

Hair follicles get stuck under the skin in the natal cleft resulting in irritation and inflammation leading to small tracts which can become infected (abscess)

Epidemiology

Much more common in MALES than females

Commonly presents between 20-30 yrs

Risk Factors

Sedentary job

Occupation involving sitting or driving

Large amount of body hair

Family history

Obese caucasians and those from Asia, Middle East and Mediterranean are at increased risk

Pathophysiology

The ingrowing of hair excites a foreign body reaction and may cause secondary tracks to open laterally with or without abscesses, with foul-smelling discharge

Clinical Presentation

Acute

Chronic

Pus filled with mould smell from abscess

Systemic signs of infection

Painful swelling over days

4 in 10 have repeated recurrent pilonidal sinus

Infection never clears completely

Diagnosis

Treatment

Detected on clinical examination

Surgery

Hygiene and hair removal advice (near sinus)

Excision of the sinus tract and primary closure and pus drainage

Pre-op antibiotics