Pilonidal Sinus Treatment in Delhi, India

Pilonidal sinus can be classified as follows:

• Acute Pilonidal Sinus: These occur one time and can cause severe pain.
• Chronic Pilonidal Sinus: These types of sinuses reoccur multiple times. These are caused when the infection is not cleared completely and are usually treated with surgery.

Pilonidal sinus (PNS) usually doesn’t exhibit noticeable symptoms. However, if there is a formation of pus, cyst, or an abscess, one may experience the following symptoms:

• Swelling of cysts
• Pain while sitting
• Pus or blood oozing from the affected area
• Low-grade fever
• A foul odour from the pus
• Fatigue
• Nausea
• More than one sinus tract

There has been no clear explanation for the cause of pilonidal sinus. However, researchers have pointed out that it may be caused due to multiple reasons. The condition can occur due to local pressure or friction from the clothes. In some cases, the sinus can occur due to friction caused by activities like sitting.

This can cause the hair growing in the area to retract back under the skin, causing inflammation, and the body’s immune response creates a cyst around the hair. Researchers also believe that the problem may develop due to a minor abnormality formed since birth. Apart from this, hormonal changes are also believed to cause this problem.

Usually, a physical examination is performed to check the crease of the buttocks to find any signs of pilonidal sinus. They are generally visible to the naked eye. The doctor may discover a pimple or oozing cyst. In rare cases, advanced tests like CT or MRI scans can also be needed to check for any sinus cavities under the skin’s surface.

Treatment for pilonidal sinus depends on various factors, including symptoms, size of the sinus, and its types. These may include:

• Conservative Treatment: If the pilonidal sinus is diagnosed early, the doctor may recommend using broad-spectrum antibiotics to treat it. A broad-spectrum antibiotic is used to treat a wide range of bacteria that may cause this problem. Patients must maintain proper hygiene and regularly shave their hair, followed by regular follow-ups.
• Incision and Drainage: A small incision opens the infected cyst and drains the fluid in this procedure. The hair follicles present in the area are removed, and the incision is sealed with stitches.
• Phenol Injection: In this procedure, the doctor injects a small dose of antiseptic phenol into the cysts. Anaesthesia is administered to the patient before the procedure. Phenol injection can be repeated several times to treat pilonidal sinus.
• Lancing: The surgeon uses a scalpel to open the injected cyst or abscess in this procedure. The surgeon then cleans the hair, blood, and debris from the cysts and packs the wound with a sterile dressing, which allows it to heal from the inside out.
• Wide Excision: This is a surgical procedure used to treat chronic pilonidal sinus. The surgeon cuts out the sinus along with a wide margin of the skin around it. The wound is not stitched and is left to heal by itself.
• Excision and primary closure: In this surgical procedure, the surgeon cuts out the skin section that contains the sinus and then stitches it back together. The procedure allows the wound to heal quickly, though it has a higher risk of a recurrence of the condition.
• Plastic Surgery: The doctor may recommend plastic surgery to treat this condition in some cases.

Pilonidal sinus is generally non-threatening. However, it can result in other complications like inflamed or swollen skin, foul odour, severe pain, low-grade fever, and more. Certain factors may also increase the risk of developing pilonidal sinus, including obesity, inactive lifestyle, excess body hair, and male and young adults.

The outlook for pilonidal sinus is positive. Depending on the severity of the condition and the type of treatment, the pilonidal sinus goes away within 4 to 8 weeks. Surgical treatments allow a person to resume daily activities with a minor hindrance. In most cases, it is advisable to maintain proper hygiene and shave the hair growing in the area regularly to reduce the chance of recurrent pilonidal sinus.

Reviewed by Dr. Pradeep Chowbey, Chairman - Max Institute of Laparoscopic, Endoscopic, Bariatric Surgery & Allied Surgical Specialities on 24-Feb-2023.