Pilonidal disease, also known as pilonidal cyst or sacrococcygeal fistula, is a condition where a cyst or abscess near the tailbone (coccyx) contains hair and skin debris. While it most commonly occurs in the sacrococcygeal area, it can also be found in the armpits, groin, navel, and between the fingers. Previously thought to be congenital, it is now understood to be acquired.

Causes of Pilonidal Disease:

Entry of Hairs Under the Skin: This is the principal cause. Hairs, particularly those shed from the head and back, find a conducive environment to enter the skin, usually through small pits or holes, and accumulate there. Friction and movement can drive these hairs into the skin, leading to the formation of small abscesses and inflammation. The accumulated hairs are perceived as foreign objects by the body, which continuously irritates and attempts to expel them, leading to fluid secretion. If the entry path is blocked, an abscess forms, seeking a way out.

Inadequate Hygiene: Poor cleaning of the area, especially not showering daily and keeping the region moist, can facilitate hair entry.

Hormonal Factors: The disease’s prevalence in young, hairy men suggests hormonal factors play a role. However, it can also occur in hairless young women.

Microtraumas: The occurrence in the sacrococcygeal area and other parts of the body supports the theory that small traumas contribute to the disease’s development. Long periods of sitting, moisture and lack of air in the tailbone area, minor impacts, and sudden changes in sitting habits can facilitate the entry of hair beneath the skin.

Depth of the Intergluteal Sulcus: In some individuals, either structurally or due to weight, the groove between the buttocks is deeper, leading to increased sweating, poor cleaning, and easier entry for hairs.

Obesity: In overweight individuals, the intergluteal cleft is deeper. This condition also leads to increased sweating and insufficient hygiene in the area.

Genetic Factors: The occurrence of the disease in multiple members of a family and its appearance in hairless girls indicate a genetic component.

Understanding these causes can help in preventing and treating pilonidal disease by maintaining good hygiene, avoiding prolonged sitting, and managing weight.

Pilonidal disease typically occurs with the following demographic and lifestyle characteristics:

Age: It is more commonly found in people under the age of 40. The prevalence decreases significantly with age.

Gender: The condition is more frequently seen in males compared to females, with the ratio being approximately two men for every woman affected.

Occupation and Lifestyle: Individuals in professions or lifestyles that require prolonged sitting, such as drivers, soldiers, and students, are more prone to developing pilonidal disease. Long periods spent sitting at a desk and incorrect sitting habits, such as slouching towards the tailbone, can facilitate the entry of hairs into the skin.

Weight: Pilonidal disease can occur in individuals of any weight, but it is somewhat more common in those who are slightly overweight. However, it is not exclusive to this group and can affect individuals regardless of their body mass.

Hairiness: While the disease is more prevalent among hairy individuals, indicating a link with body hair, it can also occur in people with minimal or no body hair. This suggests that small hairs and fibers, possibly from clothing or external sources, can contribute to the condition.

Genetic Factors: The occurrence of pilonidal disease in multiple family members suggests a genetic predisposition to the condition.

Understanding these risk factors can help in taking preventive measures, such as maintaining proper hygiene, minimizing prolonged sitting periods, and adopting correct sitting postures to reduce the likelihood of developing pilonidal disease.

Pilonidal sinus abscess drainage procedure:

Pilonidal disease is a condition that requires timely surgical treatment. If not treated on time, the area becomes inflamed, and pus (inflammatory fluid) accumulates, turning into an abscess. Just like other abscesses, draining a pilonidal abscess as soon as possible is the most appropriate treatment approach. Draining the inflammation initially prevents the abscess from growing and then starts the treatment process.

The more the treatment of the abscess is delayed, the more the pus (inflammatory fluid) inside the tissue increases; this causes the abscess and the underlying cyst, namely the hair cyst, to grow and progress. As the disease spreads, the amount of tissue that needs to be removed through normal surgery also increases; this makes the surgery bigger and more complicated.

How Should Pilonidal Disease Treatment Be?

The treatment of pilonidal disease should enable the patient to return to work and social life as soon as possible. The treatment should have the following characteristics:

• The pain should be at a minimum level.
• The patient should not be hospitalized if possible; if hospitalized, they should be discharged as quickly as possible.
• It should not require general anesthesia.
• The patient should not have to walk around with a drain (a tube placed at the wound site) at home or in the hospital for days.
• The patient should not have to lie face down or avoid sitting for days.
• The rate of recurrence (relapse) should be low.
• Risks such as bleeding, wound infection, and stitch opening should be minimal and easily controlled if they occur.
• There should be no deformation in the buttock area after treatment, the scar should be minimal, and the gluteal sulcus (the indentation of the buttocks) should not become deeper.

These characteristics are indicative of an ideal surgery. Methods like Microsinusectomy-Bascom, Karydakis, and laser treatments are considered ideal treatment options when evaluated according to these criteria.

Kıl Dönmesi Tedavisi Yöntemleri:

Bascom Ameliyatı (Mikro Sinüsektomi): Bu yöntem, olabilecek en küçük kesi ile kıl yumağını, etrafındaki kapsülü ve ciltteki giriş çıkış delikleriyle birlikte çıkarmayı amaçlar. Dünya genelinde Bascom adıyla bilinen bu yöntem, kisti orta hattın yanından yapılan bir kesi ile çıkarır. Orta hattaki delikler, pit pikhing yöntemi ile nokta şeklinde çıkarılır. Lokal anestezi ile yapılabildiğinden hastanede yatış gerektirmez. Enfeksiyon, kanama, cilt açılması gibi problemler nadirdir ve oluşsa bile büyük bir problem yaratmaz. Sosyal hayattan fazla uzak kalmadan erken dönemde işe dönüş mümkündür.

Lazer Tedavisi: Kıl kistinin içi temizlenir ve lazerle kapatılır. Kapsül yerinde bırakılır. Lokal anestezi ile yapılabileceğinden, hastalar kısa sürede işlerine dönebilirler. Ağrı minimaldir ve istenilen pozisyonda yatmak mümkündür. Dezavantajı, büyük pilonidal sinüslerde başarı oranının düşük olmasıdır.

Karydakis Ameliyatı: Bu teknik flep kaydırma ameliyatıdır. Geniş doku kayıpları ve kesiler olmadan, orta hattın bir tarafından diğer tarafa doğru yaklaşık 1 cm kaydırma yapılır. Amacı, orta hattaki derinliği azaltmaktır. Genel anestezi gerektirdiğinden, en az bir gün hastanede yatış gerektirir.

Açık Bırakma Tekniği: Hastalıklı doku, etrafındaki zarla birlikte çıkarılır ancak yara kapatılmaz ve vücut kendi kendine yarayı iyileştirmeye çalışır. Bu yöntemin avantajları arasında ameliyatın kısa sürmesi ve lokal anestezi ile yapılabilmesi yer alır. Ancak, yaranın kapanması için gereken uzun süreç, özellikle genç hastalar için ciddi bir dezavantajdır.

Primer Kapama Yöntemi: Hastalıklı alan, etrafındaki sağlam dokuyla birlikte çıkarılır ve yara dikişle kapatılır. Eğer yara büyükse, bir dren yerleştirilir. Dikişlerdeki gerginlikten dolayı yara açılma riski yüksektir.

Flep (Doku) Kaydırma Yöntemleri: Hastalıklı alan geniş bir şekilde çıkarılır ve bu alanın kapanması için yan dokudan geniş bir doku getirilir. Genel anestezi altında yapılan bu ameliyat, en az 1-2 gün hastanede yatış gerektirir. Yara iyileşmesi için genellikle 15 gün kadar yüzü koyun yatmak gerekir. İşe dönüş süresi, hastalığın ciddiyetine bağlı olarak uzayabilir.