From the Guidelines
Pilonidal sinus diagnosis involves identifying a recurrent abscess or cyst at the base of the spine or buttocks area, and treatment typically involves drainage and antibiotics.
Diagnosis
- A diagnosis of Pilonidal sinus is considered when a patient presents with a recurrent abscess at the base of the spine or buttocks area, which may be associated with a pilonidal cyst 1.
- The presence of a recurrent abscess at a site of previous infection should prompt a search for local causes such as a pilonidal cyst 1.
Treatment
- Treatment of Pilonidal sinus typically involves drainage of the abscess and culture of the abscess to guide antibiotic therapy 1.
- A 5- to 10-day course of an antibiotic active against the pathogen isolated may be prescribed to treat the infection 1.
- It is essential to drain recurrent abscesses early in the course of infection and consider further evaluation and treatment to prevent future recurrences 1.
From the Research
Diagnosis of Pilonidal Sinus
- Pilonidal sinus disease is a chronic acquired condition leading to significant morbidity and associated healthcare costs 2
- The pathomechanism of pilonidal sinus disease has still not been conclusively clarified, but it is assumed that the hair in the natal cleft contributes significantly to the formation 3
- The disease often has a significant impact on the quality of life of the affected person, and the treatment may be complex and needs to be adapted to the patient's needs 3
Treatment Options for Pilonidal Sinus
- Several techniques have been described to manage pilonidal disease, with no treatment gaining universal acceptance 2
- Treatment options include:
- Wide excision with or without primary closure 4, 2
- Various flap closures, such as Karydakis flap, Limberg flap, and Bascom cleft lift 5
- Less invasive surgical techniques, such as sinusectomy and endoscopic approaches 4, 2, 5
- Conservative nonoperative management strategies, including improved hygiene, depilation, and lifestyle modification 5
- Epilation techniques using laser and intense pulse light therapy 5
- Phenol and fibrin injection to promote closure of pilonidal sinuses 5
Considerations for Treatment
- The management of pilonidal disease must strike a balance between recurrence and surgical morbidity 4
- The ideal treatment for pilonidal disease would be simple and cost-effective, cause minimal pain, have a limited hospital stay, low recurrence rate, and require minimal time off from school or work 4
- Treatment of pilonidal disease requires patient-oriented therapy planning, and the patient must be taught the different treatment options and a treatment recommendation must be given to the patient 3
- There is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms 5