PILONIDAL SINUS

• Pilonidal sinus means nest of hairs in Greek. Also called Jeep bottom because it is very common in jeep drivers
• It is an acquired condition, commonly found in hairy males. It is found in the natal cleft overlying the coccyx, consisting of one or more, usually non-infected, midline openings, which communicate with a fibrous track lined by granulation tissue and containing hair lying loosely within the lumen
• Patients usually complain of painful swelling associated with or without blood stained foul discharge at the bottom of the spine

Sites of pilonidal sinus:

• Midline over the coccyx
• Interdigital cleft of barbers
• Axilla
• Umbilicus
• Interdigital web of the foot of a worker in hair mattress factory
• Face

Contents of tract

• Hairs – usually dead and are found lying loose in the sinus, embedded in the granulation tissue or buried deep in the mature scar tissue at the depth
• Granulation tissue
• Epithelial scales and debris

• Male gender , Hirsute individuals
• Increased sweating/moisture
• Sitting occupations (or sedentary lifestyle)-friction movements
  • Driver of vehicle(own hair)
  • Barber(customer hair)
  • Bird keeper/sheep keeper(Animal hair)
• Folliculitis or a furuncle at another site on the body
• Deep/narrow natal cleft
• Hair within the natal cleft (local irritation)
• Obesity – risk factor for recurrent disease – Buttock friction
• Poor personal hygiene
• Local trauma(army recruits)

• External opening of the sinus seen just above the anal verge in the midline over the coccyx
• A tuft of hairs projects from its mouth
• Blood stained foul discharge from the sinus
• Pain and tenderness due to recurrent infection
• There may be secondary openings on either side of the middle or a little away from the main sinus

Complications:

• Abscess formation
• Recurrent inflammation
• Recurrence of sinus formation

• Best elicited by history and physical examination findings
• Complete blood count- Hb, TLC, DLC, ESR
• Discharge for C/S and Cytology
• X-RAY of the part to rule out Osteomyelitis, foreign body
• CT Sinusogram

• Conservative- Cleaning out the tracks and removal of all hair, with regular shaving of area and strict hygiene
• Operation – excision of all sinuses
• Marsupialization

Ayurvedic Treatment

Internal medicines

• Manjishtadi Kashaya
• Punarnavadi Kashaya
• Guggulupanchapala choorna
• Kankayana vati
• Kanchanara guggulu
• Vilwadi gutika
• Avipathi choorna
• Gandhaka Rasayana
• Madhusnuhhi rasayana

Procedure

• Varti - Jatyadi
• kshara sutra