Materiały źródłowe

• #1 Pilonidal sinus – challenges and solutions | OAS

  https://www.dovepress.com/pilonidal-sinus-ndash-challenges-and-solutions-peer-reviewed-fulltext-article-OAS

  The history of sacrococcygeal pilonidal sinus disease (PSD) began in the early 19th century. The disease was first reported by Herbert Mayo in 1833 and first defined as pilonidal sinus by Richard Manning Hodges in 1880. It is common, particularly in young adults. The disease may be associated with sex hormones because it is most commonly observed between puberty and 40 years of age; furthermore, it may be associated with a more hirsute nature because it is more frequently observed in males than in females. […] Having treated thousands of PSD cases over 35 years of practice, Karydakis stated that various factors predispose patients to hair insertion, which results in PSD. Factors such as the H-factor (hair), F-factor (forces such as depth and narrowness of the natal cleft), and V-factor (vulnerability) act together and cause first hair insertion, which is followed by the easy insertion of other hairs and, finally, development of PSD. Different from this theorem, Bascom noted that the primary pathology of pilonidal sinus originates from the follicle and the normal follicle becomes a stretched follicle and an epithelial tube over time; a chronic abscess cavity and hair insertion develop secondary to these changes.

• #1 Disease that should be remembered: Sacrococcygeal pilonidal sinus disease and short history

  https://www.wjgnet.com/2307-8960/full/v3/i10/876.htm

  Pilonidal sinus disease has led to heated debates since it was first described in the medical literature. […] Although its name has been the same for about two centuries, some other names such as Jeep Disease have also been used depending on the population affected by the disease. At present, it is indisputable that the disease is acquired. […] Discussions about pilonidal sinus disease are still hot even though it was described 200 years ago. In the previous years, there were many fevered arguments and many theories to describe whether the disease is congenital or acquired. […] According to the congenital disease theory, it might have originated from caudal remnants of the neural tube, dermal inclusions produced by sequestrated epithelial structures or dermal tractions that are produced during the involution of the tail during embryonic development.

• #1 Pilonidal Disease: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/192668-overview

  Pilonidal disease is now widely considered to be an acquired disorder, on the basis of observations that congenital tracts do not contain hair and are lined with cuboidal epithelium. […] The recurrence of the disorder after complete excision of the disease tissue down to the sacrococcygeal fascia and the high incidence of chronic pilonidal sinus disease in patients who are hirsute further support an acquired theory of pathogenesis. […] After the onset of puberty, sex hormones affect the pilosebaceous glands, and subsequently, the hair follicle becomes distended with keratin. In pilonidal disease, a folliculitis develops, which produces edema and follicle occlusion. The infected follicle extends and ruptures into the subcutaneous tissue, forming a pilonidal abscess. This results in a sinus tract that leads to a deep subcutaneous cavity.

• #1 Pilonidal Cyst and Sinus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557770/

  Pilonidal disease is considered an acquired disease. Patey et al. proposed the hypothesis of pilonidal disease being an acquired disease, suggesting that pilonidal disease results from the suction of hair from surrounding soft tissue and skin, ultimately leading to a foreign body reaction and foreign body granuloma. This proposal of pilonidal disease being an acquired, infective, and foreign body reaction was corroborated by King around the same time. […] Karydakis simplified the description of the etiologic process citing three main factors- the hair or foreign body, a force causing deposition of hair into the sinus, and skin vulnerability. […] The pathophysiology is mostly unknown; the etiology is thought to be related to trapped hair follicles (as noted above). […] Microscopically its noted that hair within the pilonidal cysts originates from the overlying, surrounding skin; but, the follicles are never found within the wall of the cyst but rather free in granulation and scar tissue. The walls of pilonidal cysts are not lined with squamous epithelium but are composed of vascular pyogenic granulation tissue. In 1984, Stelzner used light microscopy to note hairs obtained from pilonidal pits had a hook architecture and suggested hair migration was unidirectional. Electron microscopy has also been used to evaluate hair involved in the pathogenesis of pilonidal disease; Dahl et al. confirmed the hook morphology and proposed sharp ends contribute to hair piercing the skin, with hooks preventing retraction. Gosselink et al. suggest the orientation of the hair scales likely encourages hair to be driven deeper into the tissue.

• #1 Pilonidal Cyst and Sinus: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/788127-overview

  It has been postulated that hair penetrates into the subcutaneous tissues through dilated hair follicles, which is thought to occur particularly in late adolescence, though follicles are not found in the walls of cysts. Upon sitting or bending, hair follicles can break and open a pit. Debris may collect in this pit, followed by development of a sinus with a short tract, with a not clearly understood suction mechanism involving local anatomy, eventually leading to further penetration of the hair into the subcutaneous tissue. […] A foreign body-type reaction may then lead to formation of an abscess. If given the opportunity to drain spontaneously, this may act as a portal of further invasion and eventually formation of a foreign body granuloma. Infection may result in abscess formation. Increased sweat may also contribute to development of a cyst and sinus. […] In summary, 3 pieces are instrumental in this process: (1) the invader, hair; (2) the force, causing hair penetration; and (3) the vulnerability of the skin.

• #1 Pilonidal Disease: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/192668-overview

  Loose hairs are drilled, propelled, and sucked into the pilonidal sinus by friction and the movement of the buttocks whenever a patient stands or sits. This bending and sitting action tightens the skin of the gluteal cleft and lifts it from the fascia. The negative pressure drives hair deeper into the sinus and appears to be exaggerated with a deep gluteal cleft. […] Hair enters tip first, and the barbs on the hair prevent it from being expelled, causing the hair to become entrapped. Physical examination occasionally may reveal a tuft of hair emerging from the midline opening in the natal cleft. This trapped hair stimulates a foreign body reaction and infection.

• #1 Approach to Interdigital Pilonidal Sinus: Our Clinical Experience and Literature Review | ClinMed International Library | International Journal of Surgery Research and Practice

  https://clinmedjournals.org/articles/ijsrp/international-journal-of-surgery-research-and-practice-ijsrp-3-042.php?jid=ijsrp

  Histological studies on samples of pilonidal sinus disease reveal that hair fragments that penetrate the skin are first surrounded by nonspecific inflammatory infiltrate and granulomas and then develop a foreign body granulomatous reaction. […] The best method to treat this disease and prevent recurrence is protection. […] The preventive recommendations provided in the literature are not practical for hairdressers because they work with their hands in a wet environment.

• #1 Pilonidal sinus pathology

  https://dermnetnz.org/topics/pilonidal-sinus-pathology

  Pilonidal sinus is a common condition typically affecting the region of the base of the spine or the intergluteal cleft. It is regarded by many authors within the follicular occlusion tetrad as the primary process appears to be follicular occlusion. […] Sections show a dense inflammatory reaction usually occupying the entire dermis with erosion and ulceration of the overlying epidermis. Free hair shafts are often seen coursing through the inflammatory focus. Surrounding the free hair shafts is a polymorphous infiltrate which may be rich in plasma cells and lymphocytes. Foreign body-type giant cells and neutrophilic abscesses are also commonly observed. […] Follicular occlusion tetrad Hidradenitis suppurativa (acne inversa), acne conglobata (severe nodulocystic acne), dissecting cellulitis (perifolliculitis capitis abscedens et suffodiens) will show a similar histopathology. Correlation with the clinical findings is helpful. Squamous cell carcinoma has been reported to occur within pilonidal sinuses. Though rare, careful examination of the squamous epithelium, particularly in cases with a marked epithelial reaction pattern is prudent.

• #1 Pilonidal disease – Wikipedia

  https://en.wikipedia.org/wiki/Pilonidal_disease

  Pilonidal sinus pathogenesis is believed to involve a mechanical process where hair and skin debris get sucked into the subcutaneous tissues through skin openings called pits. […] Hair insertion is the causative agent of pilonidal cysts. […] One proposed cause is ingrown hair, although hairs found in pilonidal sinus tracts have more often been found to originate from the head. […] Excessive sweating can also contribute to the formation of a pilonidal cyst: moisture can fill a stretched hair follicle, which helps create a low-oxygen environment that promotes the growth of anaerobic bacteria, often found in pilonidal cysts. The presence of bacteria and low oxygen levels hamper wound healing and exacerbate a developing pilonidal cyst.

• #1 Rethinking the causes of pilonidal sinus disease: a matched cohort study | Scientific Reports

  https://www.nature.com/articles/s41598-021-85830-1

  Our understanding of pilonidal sinus disease (PSD) is based on a paper published 29 years ago by Karydakis. […] Thus sweating may have a protective effect in PSD rather than being a risk factor. […] However, the pathomechanism of PSD has never been fully clarified. […] For decades surgeons have assumed that maceration of the IGF is a risk factor for PSD and that pilonidal patients sweat more than people without the disease. Our analysis adjusting for confounding disproves this. […] Thus our findings overturn long-standing assumptions about the genesis of PSD. […] If the IGF were totally dry, no hair would be retained by adhesion. […] However, we did not see any of these effects in our German PSD cohort. […] Three different statistical techniques that adjust for confounding consistently demonstrated less sweating in PSD patients. […] Our findings present a different picture of pilonidal disease than the one provided by Karydakis. […] Future research into PSD should focus on skin texture changes, hormonal changes during puberty, age-related sweating, hair strength, and skin-to-hair-strength ratio changes.

• #1 Pilonidal sinus disease: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003253.htm

  Pilonidal sinus disease is an inflammatory condition involving the hair follicles that can occur anywhere along the crease between the buttocks, which runs from the bone at the bottom of the spine (sacrum) to the anus. The cause of pilonidal disease is not clear. It is thought to be caused by hair growing into the skin in the crease between the buttocks. […] This problem is more likely to occur in people who: Are obese, Experience trauma or irritation in the area, Have excess body hair, particularly coarse, curly hair.

• #1 Pilonidal sinus – Causes & treatment | Glasgow Colorectal Centre

  https://www.colorectalcentre.co.uk/pilonidal_sinus.html

  The exact cause of a pilonidal sinus is unclear, although it’s thought to be caused by loose hair piercing the skin. Certain things can increase your chances of developing a pilonidal sinus, such as being obese, having a large amount of body hair (especially thick stiff body hair), and having a job that involves a lot of sitting or driving. The condition is more common if there is repeated trauma to area, especially in the presence of poor hygiene. […] It was thought that bouncing on hard metal seats when with driving on poor roads and over potholes contributed to the development of the condition which became known as Jeep seat disease. […] Having a family history of the condition may also be important more than one-third of people have a family member with the condition. […] A pilonidal sinus is the tract or small tunnel which contains hairs. Most commonly these occur underneath the skin between the buttocks (the natal cleft). They may become infected and can give rise to an abscess or discharge from the area.

• #1 Approach to Interdigital Pilonidal Sinus: Our Clinical Experience and Literature Review | ClinMed International Library | International Journal of Surgery Research and Practice

  https://clinmedjournals.org/articles/ijsrp/international-journal-of-surgery-research-and-practice-ijsrp-3-042.php?jid=ijsrp

  Interdigital pilonidal sinus disease, also called „barber’s disease,” is an acquired occupational disease. […] Although the etiology has not been fully clarified, the disease is thought to be mostly caused by the formation of an acute and chronic infection focus under the skin by hair shed from the skin. […] The histological structure of interdigital pilonidal sinus disease (IPSD) observed in barbers was defined as a foreign body granuloma for the first time in 1942 by Templeton. […] IPSD is now generally accepted as an acquired disease independent of body location. […] In addition, IPSD is known as an occupational disease among barbers because the sinuses develop a foreign body reaction against customers’ hair. […] The disease progresses with the formation of a sinus and eventually a cyst.

• #1 Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options – PubMed

  https://pubmed.ncbi.nlm.nih.gov/12750948/

  Sacrococcygeal pilonidal disease is a common and well recognized entity. For many years the cause of sacrococcygeal pilonidal sinus has been matter of debate. […] In dealing with the pathogenesis of pilonidal sinus disease, Karydakis attributed the hair insertion process to three main factors: the invader, i.e. the loose hair; the force, which causes the insertion; and the vulnerability of the skin to the insertion of hair at the depth of the natal cleft. The sinus is initiated from a small midline opening lined by stratified squamous epithelium. […] Malignant transformation is rare but cases of squamous cell carcinoma and verrucous carcinoma have been reported.

• #1

  http://pat.zsmu.edu.ua/article/view/22589

  The important role in the consistent development of pathogenetic mechanisms of sinus ducts formation in sacrococcygeal pilonidal disease is played by common pathological mechanisms of tubular sinus ducts formation with hypertrophic skin epithelium growth in the external sinus tract area and on the fundus of enlarged hair follicle with epithelial polyp formation. […] Pilonidal disease has an acquired origin and develops when the loose hair shafts penetrate into skin through the destroyed hair follicles in the intergluteal cleft. […] Pilonidal cyst formation is associated with hyperergic cell immunopathological delayed-type reaction that develops in soft tissues of sacrococcygeal area. […] The application of special methods of immunohistochemistry and morphology is necessary for more comprehensive evaluation of histogenetic mechanisms of sacrococcygeal pilonidal cyst formation.

• #1 Pilonidal sinus of eyelids: A rare presentation – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/pilonidal-sinus-of-eyelids-a-rare-presentation/

  Pilonidal sinus (PS), a term first used by Hodges in 1880, is a lesion that arises in the midline, in a skin dimple, in relation to the tip of the coccyx. […] Initially, congenital theories were suggested for pathogenesis of PS, but most recently acquired theory has been widely accepted by surgeons. […] Therefore, with current knowledge, we hypothesize that the routine procedure of plucking (threading) of eyebrows may have initiated the suction force, which is required for pathogenesis. The wrinkled skin present over eyelids could have contributed to the penetration of hair. Three pieces are instrumental in this process: (1) The invader, hair; (2) the force, causing hair penetration; and (3) the vulnerability of the skin. […] Kurokava et al conducted a study to elucidate the pathogenesis of PS by evaluating its cytokeratin (CK) expression and suggested PS to be part of follicular occlusion disease based on CK expression.

• #1 Pilonidal sinus – challenges and solutions | OAS

  https://www.dovepress.com/pilonidal-sinus-ndash-challenges-and-solutions-peer-reviewed-fulltext-article-OAS

  The treatment of recurrent disease is more difficult than that of primary disease. The anatomical changes following prior treatment, the removed tissue, and the invasiveness of the current disease dictate the preferred treatment approach. […] Among the nonsurgical treatment options, crystallized phenol application is frequently used. […] Although it requires a long recovery period, it could be used in both primary and recurrent cases because it results in earlier return to work, low morbidity, and high success rates. […] Achieving the ideal management of PSD requires a staging system. It is necessary to define a staging system consistent with the varied clinical presentations of the disease, resulting in a stage-specific treatment approach. […] Currently, there is no standard, recommended treatment for all patients with PSD. An individualized approach that assesses the extent of disease, social status, and expectations of the patient would be ideal.

• #1 Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence | Scientific Reports

  https://www.nature.com/articles/s41598-018-20143-4

  The highest incidence of recurrence identified in our data, 67.9%, occurred 240 months after primary midline closures; so, this method should be abandoned straight away, while other traditional approaches such as primary open treatment can be justified, also when considering the development of more complicated surgeries involving flap techniques. […] From our analysis of data from more than 80,000 patients over 18 decades, we found that the Karydakis and the Bascom cleft lift procedures show the lowest recurrence at any time of follow-up, followed by rhomboid flaps and other flaps. […] Our results presented here suggest that the variances in recurrence are understandable once the follow-up time is taken into account. […] In conclusion, physicians must keep in mind that recurrence of surgical procedures in PSD impressively depend on follow-up time. […] The choice of surgical therapy influences recurrence by a factor of up to 21.

• #1 Pilonidal sinus and endoscopic surgery—myth or reality? – Milone – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/4281/5120

  A new endoscopic treatment for pilonidal sinus has been recently proposed: the Video Assisted Ablation of Pilonidal Sinus (VAAPS) technique. Its rationale is based on the concept of complete removal by ablation of the sinus though a small surgical access. […] Although the mechanism of treatment is similar to the sinusectomy, the video-assisted technique benefits from a magnified view by the endoscope that allows the identification of the sinus borders, its lateral tracks, if present, and the presence of hair and debris inclusions in the cavity. […] It is worth mentioning that, according to Milone et al., this treatment could be an effective and feasible treatment for pilonidal sinus, being connected to a similar rate of postoperative complications compared with the conventional treatment. […] Furthermore, further RCT comparing endoscopic treatment with sinusotomy or off-midline procedure are needed to confirm superiority/non-inferiority of this endoscopic procedure.

• #1 Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease | Clinics

  https://www.elsevier.es/en-revista-clinics-22-articulo-effectiveness-limberg-karydakis-flap-in-S1807593222013849

  Pilonidal sinus (PS) is a common disease of the natal cleft in the sacrococcygeal region with weak hair accumulation occurring in the hair follicles, which can be chronic and undergo acute exacerbation. […] The etiology and pathogenesis of PS are not clear, although the disease is thought to be related to the accumulation of weak and lifeless hair in the intergluteal region. Over time, foreign body reaction occurs, causing abscess and sinus formation. […] The etiology and pathogenesis of PS is frequently associated with both congenital and acquired factors. It has been suggested that PS starts as a chronic process involving the accumulation of lifeless hairs and subcutaneous hair deposition in the intergluteal region that leads to inflammation and infection. […] The LF and KF procedures not only cover the wound but also, in theory, flatten the natal cleft and decrease hair accumulation, mechanical irritation and the risk of recurrence. […] Limberg flap rotation is clearly preferred for safety reasons given its low recurrence and complication rates.

• #2 Pilonidal sinus and endoscopic surgery—myth or reality? – Milone – Annals of Laparoscopic and Endoscopic Surgery

  https://ales.amegroups.org/article/view/4281/5120

  Pilonidal Sinus is a disease frequently encountered in clinical practice, nevertheless its treatment has remained controversial, since it was first described by Mayo in 1833. […] A minimally invasive procedure aimed to the treatment of pilonidal sinus is recently started to spread. Thus, in the era of minimally invasive surgery, could endoscopic approach be a new way to treat pilonidal sinus? […] The idea of a less radical treatment of pilonidal sinus goes back to World War II. During the world conflict in fact, Phillips suggested a less invasive treatment of infected pilonidal sinuses to keep the fighting man in a fit condition for combat. […] In the last decade, supported by the statement less is more many surgeons developed minimally invasive treatment of pilonidal sinus. […] Minimally invasive techniques for pilonidal sinus consist of sinusectomy, it means the circumferential incision of the pilonidal orifices avoiding cutaneous margins and a selective subcutaneous extirpation of the sinus without closure of the wound.

• #2 Disease that should be remembered: Sacrococcygeal pilonidal sinus disease and short history

  https://www.wjgnet.com/2307-8960/full/v3/i10/876.htm

  It was detected to be particularly common among jeep drivers. It was emphasized that compression and irritation reaching the coccyx is important in the etiology and Buie stated that the disease is acquired in his article named The Jeep Disease. […] Karydakis, who published the largest pilonidal sinus case series in 1992, developed the most logical theory about the etiology and etiopathogenesis of the disease. He reported as a result of his 35 years of work on pilonidal sinus that the etiology is acquired. […] Hair penetration process is the basis of pilonidal sinus according to Karydakis. Three main factors play a role in embedding of hair: Invaders formed by free hair (H-hair), the force that provides hair embedding the (F-force), and the vulnerability of the skin that lets the embedding of the hair deeper in the gluteal region (V-vulnerability). Pilonidal sinus disease develops in cases in which these three factors are present together and the disease development possibility could be calculated with HxFxV formula. […] As a result, recently most of surgeons are in the opinion that the disease is acquired.

• #2 Pilonidal Cyst and Sinus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557770/

  Pilonidal disease is considered an acquired disease. Patey et al. proposed the hypothesis of pilonidal disease being an acquired disease, suggesting that pilonidal disease results from the suction of hair from surrounding soft tissue and skin, ultimately leading to a foreign body reaction and foreign body granuloma. This proposal of pilonidal disease being an acquired, infective, and foreign body reaction was corroborated by King around the same time. […] Karydakis simplified the description of the etiologic process citing three main factors- the hair or foreign body, a force causing deposition of hair into the sinus, and skin vulnerability. […] The pathophysiology is mostly unknown; the etiology is thought to be related to trapped hair follicles (as noted above). […] Microscopically its noted that hair within the pilonidal cysts originates from the overlying, surrounding skin; but, the follicles are never found within the wall of the cyst but rather free in granulation and scar tissue. The walls of pilonidal cysts are not lined with squamous epithelium but are composed of vascular pyogenic granulation tissue. In 1984, Stelzner used light microscopy to note hairs obtained from pilonidal pits had a hook architecture and suggested hair migration was unidirectional. Electron microscopy has also been used to evaluate hair involved in the pathogenesis of pilonidal disease; Dahl et al. confirmed the hook morphology and proposed sharp ends contribute to hair piercing the skin, with hooks preventing retraction. Gosselink et al. suggest the orientation of the hair scales likely encourages hair to be driven deeper into the tissue.

• #2 Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options – PubMed

  https://pubmed.ncbi.nlm.nih.gov/12750948/

  Sacrococcygeal pilonidal disease is a common and well recognized entity. For many years the cause of sacrococcygeal pilonidal sinus has been matter of debate. […] In dealing with the pathogenesis of pilonidal sinus disease, Karydakis attributed the hair insertion process to three main factors: the invader, i.e. the loose hair; the force, which causes the insertion; and the vulnerability of the skin to the insertion of hair at the depth of the natal cleft. The sinus is initiated from a small midline opening lined by stratified squamous epithelium. […] Malignant transformation is rare but cases of squamous cell carcinoma and verrucous carcinoma have been reported.

• #2 Pilonidal Sinus Disease (Pilonidal Cyst) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/pilonidal-sinus-disease-pilonidal-cyst/

  It is coarse, thick hair that will create PSD when it glides over the surface of the lower back and upper buttocks and pierces through the cutaneous barrier at the base of a pilonidal sinus funnel. […] Gravity and the morphological shape of the pelvis and buttocks also play a significant role in the development of PSD. […] It has been suggested that gravity and intergluteal motion together create a type of vacuum that directs loose hair into the funnel of the pilonidal sinus. […] It is only those men and women who have a predisposing morphologic shape and curvature of their buttocks and who routinely create rhythmical, shearing movements with their lower backs and buttocks in their occupation and normal daily activities who will develop PSD.

• #2 Pathogenesis – Primary Care Notebook

  https://primarycarenotebook.com/pages/surgery/pilonidal-sinus/pathogenesis

  The vast majority of pilonidal sinuses are acquired anomalies. Rarely, a congenital sinus may be associated with a dermoid cyst. They develop at the onset of puberty. This is when sex hormones start to act on pilosebaceous glands in the natal cleft. A hair follicle becomes distended with keratin and then becomes infected. Folliculitis ensues and an abscess extends down into the subcutaneous fat. […] Tracks form out of the cavity in the direction of neighbouring hair growth – in over 90% of cases towards the patient’s head. […] Hairs are sucked or drilled into the cavity as a result of friction with the movement of the buttocks. The hairs on the barbs act to prevent expulsion. These hair then provoke a foreign body reaction and infection.

• #2 Pilonidal Cyst and Sinus | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27223

  The pathophysiology is mostly unknown; the etiology is thought to be related to trapped hair follicles (as noted above). […] Microscopically its noted that hair within the pilonidal cysts originates from the overlying, surrounding skin; but, the follicles are never found within the wall of the cyst but rather free in granulation and scar tissue. The walls of pilonidal cysts are not lined with squamous epithelium but are composed of vascular pyogenic granulation tissue. In 1984, Stelzner used light microscopy to note hairs obtained from pilonidal pits had a hook architecture and suggested hair migration was unidirectional. Electron microscopy has also been used to evaluate hair involved in the pathogenesis of pilonidal disease; Dahl et al. confirmed the hook morphology and proposed sharp ends contribute to hair piercing the skin, with hooks preventing retraction. Gosselink et al. suggest the orientation of the hair scales likely encourages hair to be driven deeper into the tissue.

• #2 Pilonidal disease – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pilonidal-disease/

  The exact mechanism is unknown, however, the current prevailing hypothesis is that pilonidal disease is an acquired condition. […] Movement causes negative pressure (e.g., suction effect) and further penetration of hair into local subcutaneous tissue formation of a pilonidal sinus. […] These collections trigger local tissue inflammation within the pilonidal sinus acute infection (abscess) or fistulae.

• #2 Pilonidal sinus pathology

  https://dermnetnz.org/topics/pilonidal-sinus-pathology

  Pilonidal sinus is a common condition typically affecting the region of the base of the spine or the intergluteal cleft. It is regarded by many authors within the follicular occlusion tetrad as the primary process appears to be follicular occlusion. […] Sections show a dense inflammatory reaction usually occupying the entire dermis with erosion and ulceration of the overlying epidermis. Free hair shafts are often seen coursing through the inflammatory focus. Surrounding the free hair shafts is a polymorphous infiltrate which may be rich in plasma cells and lymphocytes. Foreign body-type giant cells and neutrophilic abscesses are also commonly observed. […] Follicular occlusion tetrad Hidradenitis suppurativa (acne inversa), acne conglobata (severe nodulocystic acne), dissecting cellulitis (perifolliculitis capitis abscedens et suffodiens) will show a similar histopathology. Correlation with the clinical findings is helpful. Squamous cell carcinoma has been reported to occur within pilonidal sinuses. Though rare, careful examination of the squamous epithelium, particularly in cases with a marked epithelial reaction pattern is prudent.

• #2 Pilonidal sinus – challenges and solutions | OAS

  https://www.dovepress.com/pilonidal-sinus-ndash-challenges-and-solutions-peer-reviewed-fulltext-article-OAS

  Consistent with this hypothesis, it has been demonstrated that hair was detected in histopathological examinations in only 65% of PSD cases. […] Primary PSD most frequently begins as a single-follicle disease and advances by incorporating other hair follicles. Later, the disease may fistulize to the gluteal region unilaterally or bilaterally. Because the size of the defect after surgical excision and method used to close this defect are directly associated with the clinical outcomes, the treatment approach varies according to the development stage of the disease. There is no staging system that has been defined for PSD. […] Although different authors have developed classification systems, these classifications have generally considered clinical presentations of the disease, independent of its progressive course. An ideal classification system should differentiate an acute abscess from chronic sinus disease, asymptomatic from symptomatic, and primary from recurrent.

• #2 Pilonidal sinus

  https://www.nhs.uk/conditions/pilonidal-sinus/

  It’s not clear what causes a pilonidal sinus. […] A skin problem, pressure or friction may cause hair between the buttocks to be pushed inwards. […] This may either be hair growing around the buttock area, or loose hair shed from the buttocks or elsewhere that gathers around the buttock cleft and enters the pilonidal sinus. […] Pilonidal sinuses are more common in men because they tend to be hairier. […] Sitting for long periods can also increase your chances of getting a pilonidal sinus.

• #2 Pilonidal sinus of the cheek: an extremely rare clinical entity—case report and brief review of the literature | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-020-02561-z

  Pilonidal sinus (PNS) refers to a subcutaneous sinus which contains hair. It is an acquired condition caused by penetration of hair fragments into the skin. This hair containing cavity usually is asymptomatic and the only sign of its presence may be a small pit on the surface of the skin. Due to infection of its content, it may present clinically either as a recurrent discharging sinus or an abscess. […] The etiology of pilonidal sinus remains unclear. There are two main theories regarding its etiology acquired and congenital. In general, at least three conditions need to be fulfilled for a pilonidal sinus to occur: first is hair in the skin and, second, some kind of wrinkled skin, such as the natal cleft or a scar. The third condition is a mixture of hormonal and hygienic problem. […] For PNS of the cheek to occur, repeated mechanical trauma from shaving coupled with contributions from high testosterone level, repeated folliculitis and intrusion of hair fragment through the damaged overlying skin seems to play the major contributory role.

• #2 Pilonidal sinus of the cheek: an extremely rare clinical entity—case report and brief review of the literature | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-020-02561-z

  Majority of facial PNSs occur in males. Males have facial hair which needs repeated shaving this leads to abundance of rootless razor sharp short hairs which are implicated in the pathogenesis of facial PNS. […] An ingrown hair inciting repeated irritation of the skin thereby causing its intrusion was excluded as a differential diagnosis because of the presence of many hairs deep inside the excised cyst. […] The standard method of management of facial PNS is excision and primary closure which is usually performed under general or local anesthesia. This may differentiate facial PNS from PNS of other areas where many non-surgical modalities exists.

• #2

  https://medicaljournalssweden.se/actadv/article/view/6569

  Hidradenitis suppurativa is a chronic inflammatory disorder of the hair follicle with a high level of morbidity. Pilonidal sinus disease is a comorbid disorder and may be the reason for first contact with the healthcare system of patients with hidradenitis suppurativa. The aim of this study was to evaluate the frequency of association of pilonidal sinus disease and hidradenitis suppurativa and to explore whether pilonidal sinus disease defines a different clinical profile for patients with hidradenitis suppurativa. Pilonidal sinus disease was present in 32.6% (269/839) of the patients and was associated with an early debut of hidradenitis suppurativa, a higher Hurley stage, inflammatory phenotype and a greater number of fistulas and perianal involvement. […] Elapsed time between pilonidal sinus disease and diagnosis of hidradenitis suppurativa was associated with higher disease severity. Pilonidal sinus disease is a frequent comorbidity and risk marker for hidradenitis suppurativa disease severity. Pilonidal sinus disease could be a sentinel event to identify patients who would benefit from close treatment and follow-up. […] Morphology of pilonidal sinus disease: some evidence of its being a unilocalized type of hidradenitis suppurativa.

• #2 Pilonidal sinus | PPT

  https://www.slideshare.net/slideshow/pilonidal-sinus-47289096/47289096

  Pilonidal sinus is an infection of the skin and subcutaneous tissue near the upper part of the natal cleft. It is caused by hair penetrating and becoming trapped in the skin. […] In WW II Patey and Scarf hypothesised origin of pilonidal sinus acquired by penetration of hair into subcutaneous tissue. […] Cause of pilonidal sinus (1) Invader hair (2) Force causing hair penetration (3) Vulnerability of skin. […] Pathogenesis Hair and inflammation inciting factors On sitting/bending natal cleft stretches- breakage of follicles- opening of a pore/pit- collection of debris – pilonidal sinus – abscess Proof?? Pilonidal tract extends cephalad. Cavity contains hair, debris or granulation tissue. […] Karydakis believed that hair insertion is the cause for pilonidal sinus. […] In summary Patients with acute pilonidal sinus I D For patients with chronic pilonidal sinus An excision of the sinus and all tracts A primary closure is associated with faster wound healing however a delayed closure is associated with less recurrence.

• #3 Pilonidal sinus of eyelids: A rare presentation – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/pilonidal-sinus-of-eyelids-a-rare-presentation/

  Pilonidal sinus (PS), a term first used by Hodges in 1880, is a lesion that arises in the midline, in a skin dimple, in relation to the tip of the coccyx. […] Initially, congenital theories were suggested for pathogenesis of PS, but most recently acquired theory has been widely accepted by surgeons. […] Therefore, with current knowledge, we hypothesize that the routine procedure of plucking (threading) of eyebrows may have initiated the suction force, which is required for pathogenesis. The wrinkled skin present over eyelids could have contributed to the penetration of hair. Three pieces are instrumental in this process: (1) The invader, hair; (2) the force, causing hair penetration; and (3) the vulnerability of the skin. […] Kurokava et al conducted a study to elucidate the pathogenesis of PS by evaluating its cytokeratin (CK) expression and suggested PS to be part of follicular occlusion disease based on CK expression.

• #3 Chronic Pilonidal Disease | Veterans Affairs Canada

  https://www.veterans.gc.ca/en/mental-and-physical-health/mental-health-and-wellness/compensation-illness-or-injury/disability-benefits/entitlement-eligibility-guidelines/z-index/chronic-pilonidal-disease

  The pathogenesis of pilonidal disease has been debated actively over the years, with current thinking favoring an acquired pathology as opposed to a congenital anomaly: […] There is growing evidence that tiny midline holes or pits, sometimes called sinuses, which are seen in the cleft of almost all persons with the disease, are the source of the disease. It is postulated that the pits represent distorted hair follicles. […] Sedentary occupations and constant mild trauma to the sacral area, as in driving a truck, are contributory factors. The condition, also known as „jeep disease”, was found commonly among jeep drivers during World War II. It was hypothesized that sitting in vehicles with little shock absorption for long periods drove hair ends into follicles and skin adnexal glands, initiating a foreign-body reaction, with the resulting abscess rupturing spontaneously and leaving a painful discharging sinus.

• #3 Disease that should be remembered: Sacrococcygeal pilonidal sinus disease and short history

  https://www.wjgnet.com/2307-8960/full/v3/i10/876.htm

  It was detected to be particularly common among jeep drivers. It was emphasized that compression and irritation reaching the coccyx is important in the etiology and Buie stated that the disease is acquired in his article named The Jeep Disease. […] Karydakis, who published the largest pilonidal sinus case series in 1992, developed the most logical theory about the etiology and etiopathogenesis of the disease. He reported as a result of his 35 years of work on pilonidal sinus that the etiology is acquired. […] Hair penetration process is the basis of pilonidal sinus according to Karydakis. Three main factors play a role in embedding of hair: Invaders formed by free hair (H-hair), the force that provides hair embedding the (F-force), and the vulnerability of the skin that lets the embedding of the hair deeper in the gluteal region (V-vulnerability). Pilonidal sinus disease develops in cases in which these three factors are present together and the disease development possibility could be calculated with HxFxV formula. […] As a result, recently most of surgeons are in the opinion that the disease is acquired.

• #3 The Management of Pilonidal Sinus (07.01.2019)

  https://di.aerzteblatt.de/int/archive/article/204214

  Pilonidal disease is now considered an acquired condition of the hair follicles. […] The central pathological event in these conditions is thought to be follicular hyperkeratosis, leading to obstruction of the infundibulum of a hair follicle. […] The follicle becomes dilated and ruptures, leading to secondary infection and the formation of fistulae and abscesses. […] Karydakis already hypothesized in the 1970s that fistulae arise only when free hairs perforate the vulnerable, but still intact skin. […] The hairs that are found in the subcutaneous sinus cavity seem to be broken or cut head and neck hairs, i.e., hairs that have been separated from their follicles. […] Karydakis suspected that they become implanted in the natal cleft and then bore deeper and deeper into the subcutaneous tissue, in the manner of a screw.

• #3 Pilonidal sinus of external auditory canal as unpredicted lesion: rarest case presentation and review of literatures | The Egyptian Journal of Otolaryngology | Full Text

  https://ejo.springeropen.com/articles/10.1186/s43163-023-00384-5

  The only acceptable explanation for the pathogenesis of this lesion among this child via the possibility of the foreign hair impaction at the EAC as the result of the scalp hair loss either spontaneously or during hair combing or trimming, subsequently as the immune response to this foreign body effect, the inflammatory granulomatous lesion will occur. […] This could be the same explanation for the pathogenesis of PNS among the barbers as well as animal hair trimmers, who developed this lesion at interdigital regions as the result of the pushing and impaction of the trimmed hair inward as foreign bodies. This will enhance and induce the reactive inflammatory granulomatous lesion, and it will be manifested as PNS.

• #4 The Management of Pilonidal Sinus (07.01.2019)

  https://di.aerzteblatt.de/int/archive/article/204214

  The keratin flakes of these hairs function as barbs that permit movement in one direction only. […] This theory clearly diverges from the theory of hyperkeratosis and follicular occlusion. […] Brearley showed experimentally that movement of the gluteal musculature leads to negative pressure in the pilonidal sinus, drawing the free hairs inward. […] Nonetheless, the fact that pilonidal disease can arise in the interdigital space of hairdressers seems rather to confirm the theory of Karydakis. […] In the 1930s, the sinus was thought to be an epithelialized cyst, and the notion therefore arose that the condition is congenital. […] Later, however, Patey and others showed that the subcutaneous cavity is actually lined by granulation tissue. […] There are conflicting pathogenetic hypotheses, in which fistula formation is attributed either to hyperkeratosis followed by the dilatation and rupture of a hair follicle, or else to perforation of the skin by hairs that have been shed or cut.

• #4 Pilonidal sinus of eyelids: A rare presentation – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/pilonidal-sinus-of-eyelids-a-rare-presentation/

  Pilonidal sinus (PS), a term first used by Hodges in 1880, is a lesion that arises in the midline, in a skin dimple, in relation to the tip of the coccyx. […] Initially, congenital theories were suggested for pathogenesis of PS, but most recently acquired theory has been widely accepted by surgeons. […] Therefore, with current knowledge, we hypothesize that the routine procedure of plucking (threading) of eyebrows may have initiated the suction force, which is required for pathogenesis. The wrinkled skin present over eyelids could have contributed to the penetration of hair. Three pieces are instrumental in this process: (1) The invader, hair; (2) the force, causing hair penetration; and (3) the vulnerability of the skin. […] Kurokava et al conducted a study to elucidate the pathogenesis of PS by evaluating its cytokeratin (CK) expression and suggested PS to be part of follicular occlusion disease based on CK expression.

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