A 38-year-old man is referred for evaluation and treatment of a painful lesion on his backside that he first noted over 1 year ago. The site had been drained twice by his family doctor but recurred shortly after each procedure. The lesion also has not responded khổng lồ a prolonged course of oral antibiotics. Physical examination reveals a firm nodule in proximity lớn the anal orifice that is painful lớn touch.
Pilonidal disease is an acquired disorder that may present with a constellation of findings ranging from asymptomatic hair-filled cysts lớn painful abscesses. The name is derived from the Latin words pilus meaning hair and nidus meaning nest.1 The condition was once referred lớn as jeep...
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Pilonidal disease is an acquired disorder that may present with a constellation of findings ranging from asymptomatic hair-filled cysts lớn painful abscesses. The name is derived from the Latin words pilus meaning hair and nidus meaning nest.1 The condition was once referred to lớn as jeep rider’s disease after thousands of soldiers in World War II were hospitalized with the condition.1,2
The pathophysiology of the disease is unclear but it is hypothesized that inversion of hair growth leads to a foreign-body reaction resulting in granuloma formation.2The condition is 2 to 3 times more comtháng in men than women. Risk factors include obesity, poor hygiene, coarse hair, prolonged friction, and coexisting hidradenitis suppurativa.3
The diagnosis is often made clinically based on location, identification of risk factors, & physical examination, which may range from pits or dimples at the base of the spine lớn large tracking sinuses and/or abscesses accompanied by pain, erythema, edema, & foul drainage. Chronic cases may be associated with visible tracks. Histology often reveals cystic cavities containing hair & cellular debris lined with granulation tissue.3
Treatment is divided inlớn operative vs nonoperative sầu management. Patients should be advised to lớn keep the area clean and free of hair using methods such as laser hair removal, shaving, waxing, và depilatory creams. Cysts that are not infected may resolve sầu on their own.3
Persistent & infected cysts require incision và drainage. In cases of ađáng yêu infection, treatment plans are often staged with the infection addressed first.3Excising the abscess cavity & thoroughly removing the nest of hair & skin debris has been demonstrated khổng lồ reduce recurrence and complications from wound healing.4Following wide surgical excision, defects can be closed with skin grafts và local flaps. In cases where primary closure is not a viable option, healing by secondary intent may be facilitated with negative-pressure wound therapy & wound packing.5
Sara Mahmood, DPM, is a podiatrist who completed a joint dermatology/podiatry fellowship & is on staff at the DermDox Dermatology Centers in Pennsylvania.Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Commonwealth Medical College, và clinical instructor of dermatology at Arcadia University and Kings College. Xem thêm: Loài Chó Khôn Nhất Thế Giới Mà Chủ Nên Tham Khảo, Top 9 Giống Chó Thông Minh Nhất Thế Giới
1. Karydakis GE.Easy và successful treatment of pilonidal sinus after explanation of its causative process.Aust N Z J Surg. 1992;62(5):385-389. doi:10.1111/j.1445-2197.1992.tb07208.x
2. Patey DH, Scarff RW.Pathology of postanal pilonidal sinus; its bearing on treatment.Lancet. 1946;2(6423):484-486. doi:10.1016/s0140-6736(46)91756-4
3. Johnson EK, Vogel JD, Cowan ML, Feingold DL, Steele SR; Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons.The American Society of Colon and Rectal Surgeons’ clinical practice guidelines for the management of pilonidal disease.Dis Colon Rectum. 2019;62(2):146-157. doi:10.1097/DCR.0000000000001237
5. Biter LU, Beông chồng GM, Mannaerts GH, Stok MM, van der Ham AC, Grotenhuis BA.The use of negative-pressure wound therapy in pilonidal sinus disease: a randomized controlled trial comparing negative-pressure wound therapy versus standard open wound care after surgical excision.Dis Colon Rectum. 2014;57(12):1406-1411. doi:10.1097/DCR.0000000000000240