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June 2010

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Pilonidal sinus

Management in the primary care setting

Volume 39, No.6, June 2010 Pages 372-375

Paul Kitchen


Postanal pilonidal sinus is a skin condition in the midline of the natal cleft. A primary pit forms in the midline, caused by a hair follicle that has become infected, into which loose hairs enter to create a track or abscess.


This article explains how a pilonidal sinus develops and presents, and details methods of treatment in the primary care setting and specialist management options.


The devastation of recurrence with further pain, embarrassment, and time off work or school (in some cases for months or years), plus the prospect of more surgery is still common for patients with postanal pilonidal sinus. This can be avoided with the correct management. Surgery now has methods that produce early healing, low recurrence rates and acceptable cosmetic results.

Postanal pilonidal sinus (PS) can present acutely as a pilonidal abscess, asymptomatically as a small pit or nontender lump, or as a discharging lesion with or without pain or a lump (Figure 1a, b). The two main features of the chronic sinus are:

  • a midline primary pit (or more than one) at the base of the natal cleft, which is epithelial lined and usually not inflamed and may have a hair (or several hair fragments) inserted into it that can be pulled out
  • a secondary opening which, if present, is usually on one side and cranial to the primary pit. It may be a scar of a previous opening. If open, it may discharge pus or blood and be lined by granulation tissue. There may be a palpable track leading from the midline pit. More than one secondary opening means the sinus track has branches.

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