What is ingrown hair?
– Ingrown hair is the condition where hairs pass under the skin in the coccyx, groin area, genital area, armpit and rarely in the navel, forming wounds, abscesses and fistulas (tunnels).
– Its other names are 'dermoidkist', 'pilonidal sinus' or 'sinus pilonidalis', meaning subcutaneous hair nest.– The hairs that fall from the back and head get stuck in the hairy and sweaty groove in the groove between the two buttocks in the coccyx (intergluteal sulcus), turning like a screw or drill through the sweat gland holes at the bottom of the groove, and entering into the subcutaneous fat tissue without being noticed, creating holes and destroying the bacteria that enter these holes.
– Ingrown hair (pilonidal sinus, sinus pilonidalis, pilonidal cyst) was first described in 1833. In the 1950s, it was thought that ingrown hair disease was caused by the congenital skin, fat and hair cells in the coccyx continuing their activities after the person was born. However, today it is known that this disease is not congenital and occurs later, because congenital fistulas do not contain hair. It is known that it rarely progresses to the nerve roots in the spinal cord.
Who gets ingrown hair?
– In hairy and slightly overweight young men between the ages of 16 and 30, sex hormones affect the hair and sebaceous glands.
– In Western societies, the incidence of ingrown hair is 1% in men and 0.1% in women. Studies conducted in our country have determined that the incidence of ingrown hair in young men is close to 10%, that is, approximately 10 times that of the western society. According to Turkish Statistical Institute (TUIK) data, our country's population was determined as 72.5 million in the 2010 Address-Based Population Registration System Results. It is seen that men in the 15-30 age group constitute approximately 13% of the total population, with 9.4 million people. Considering that an average of 10% of men in this age group have ingrown hairs, it can be calculated that this problem will be seen in approximately 1 million men in the 15-30 age group.
– It is rarely seen in people over the age of 40.
– White people. It is seen in black people and in the Asian continent. It is rare.
– In pilonidal sinus (sinus pilonidalis), approximately 80% of the fistula openings are located on the left side of the groove and 90% are located on the upper side of the hair entry holes.
For ingrown hairs. What are the risk factors?
– People who need to sit for long periods of time due to their job (driver, secretary, banker, architect engineer, etc.)
– Excessive friction in the hip area
– Excessive sweating
– Obesity
– Lack of hygiene
– Regional trauma
– People with boil problems in other parts of the body.
What causes ingrown hair?
strong>Ingrown hairs often cause inflammation of a hair follicle and form a boil (folliculitis or furuncle), causing swelling or edema around the hair follicle and obstruction of the hair follicle. This clogged, inflamed hair follicle bursts (ruptures) into the subcutaneous fatty tissue and forms a hair follicle abscess (pilonidal abscess). This hair follicle abscess creates a tunnel (sinus) through the skin over time, creating the classic problem of ingrown hair (sinus pilonidalis). It is known that in approximately 90% of the cases, this tunnel (pilonidal sinus) goes in the direction of the patient's head, which is the direction of hair growth. For this reason, the opening of the hole is often 5-8 cm away from the anus. In very rare cases, the tunnel (pilonidal sinus) grows downwards rather than upwards and may be 4-5 cm away from the anus. When an ingrown hair abscess (pilonidal abscess) opens towards the skin on its own, it means that a tunnel (sinus pilonidalis) has formed on the coccyx. Thus, the tunnel (sinus pilonidalis) progresses from the groove between the two buttocks (intergluteal sulcus) to the sides and makes its mouth in the skin. Loose and soft hairs are pulled or absorbed into this tunnel (pilonidal sinus) as a result of friction with the movements of the hip. The hairs enter from the tip and the root prevents them from being expelled, thus remaining trapped inside and forming a 'hair sac'. During the examination, a hair grain or bundle is often observed protruding from the midline in the coccyx. These trapped hairs cause a reaction and later infection in the body. Rarely, it is seen that foreign objects other than hair, such as bird feathers, enter these spaces.
Ingrown hair n The most common cause is in the coccyx?
Ingrown hairs occur when the skin in the groove between the two buttocks (intergluteal sulcus) becomes thinner and easily pierced and irritated due to the closed environment and the hairs advance more easily due to the pressure of the hard tailbone. . Additionally, according to an old belief, there may be a congenital predisposition to this disease, but many surgeons oppose this theory today.
What are the symptoms of ingrown hair?
– In the coccyx or behind the anus. small swellings on the upper side
– Itching
– Hairy or hairless millimetric holes (the opening of the hair sac in the skin)
– Discharge or blood coming from these holes
Ingrown hairs Which diseases may be involved?
The following diseases should be excluded in the differential diagnosis of pilonidal sinus.
-Anal fistula (perianal fistula)
– Skin boils
– Syphilis boils (granuloma) )
– Bone inflammation (osteomyelitis)
What are the symptoms of pilonidal abscess?
50% of pilonidal sinus patients are diagnosed with pilonidal abscess. They consult a doctor. In this case, severe pain and discharge are present in 70-80% of the cases. There may be just a redness in the area before an abscess develops. Abscess develops as a result of the boil progressing towards the subcutaneous fatty tissue.
Is it a problem if ingrown hair is not treated?
– Abscess and discharges become permanent in the coccyx.
– Epidermoid cancer may develop from ingrown hairs (pilonidal sinus), albeit at a low rate, after years of chronic and inflammatory discharge. It has been determined that pilonidal cancer develops on the basis of ingrown hairs after an average of 23 years, around the age of 50, and in one woman against four men.
How is ingrown hair treated?
– Ingrown hair disease can be treated without or with surgery.
– In case of abscess, it can be regressed simply with antibiotic treatment, but in advanced cases It may be necessary to surgically drain or incise the abscess. Although the abscess is drained, since the hair sac remains in place and only the pus on it is drained during this process, these hair sacs often become 'pilonidal sinus' over time. ' or 'sinus pilonidalis' They create the problem of ingrown hair.
What are the surgical treatment methods in the treatment of ingrown hair?
– Primary closure:It is the surgical removal of the cyst and the stitching of the wound.
– Leaving open:It is the surgical removal of the cyst and leaving the wound open. It is preferred in cases with abscess. It takes between 3-6 months for the wound to close.
– Introflexion:It is the surgical removal of the cyst and partial closure of the wound. It takes between 2-3 months for the wound to close.
– Flap method:Flap methods such as Limberg and Karidakis are mainly preferred. The basis of the treatment here is to shift the tissues in a different region to the space created and to divert the direction of the midline where the disease occurs.
– Removal of the fistula walls under local anesthesia (excision)
– One-day hospitalization followed by bed rest for about a week. requires. Wound healing occurs within 2-3 weeks on average.
Is surgery the definitive solution for the treatment of ingrown hair?
Although it varies depending on the techniques, after ingrown hair surgery, 5-% There are relapse or recurrence rates varying between 15 and 15.
Why does pilonidal sinus disease recur despite surgery?
After the entire hair sac is surgically removed, there is an improvement (granulation) in the surgical field. tissue is formed and the hairs of this area can pull the skin residues back there and thus create a foreign body reaction, causing the ingrown hair disease to recur.
Are there any alternative treatment methods to surgery in the treatment of ingrown hair?
Yes, there are local treatment methods alternative to surgery in the treatment of ingrown hair. In case of ingrown hair abscess, it is known that applying pomade, popularly known as black ointment (a mixture of crude oil properties treated with sulfuric acid and made soluble in water), is effective but only provides a temporary solution to the problem.
It is the most effective in the local treatment of ingrown hairs. Chemical substances such assilver nitrate and phenol are frequently used. B. These chemical substances are injected through the fistula entrances and these procedures are completed in approximately 10-15 minutes. Recovery is expected to occur within an average of 4-6 weeks, with weekly or bi-weekly checks. Sometimes it may be necessary to cut the relationships between fistulas under local anesthesia. When performed by experienced hands under appropriate conditions, very positive results can be obtained and the chance of recurrence is around 8-10%. The patient must visit the doctor several times in a row for wound care. Some surgeons believe that pilonidal sinus disease will spontaneously regress after the age of 40, no matter what method it is treated with, so they do not recommend surgery unless there is a complicated disease. Supporters of this view have been increasing in recent years. With an increasing trend towards natural medicines and alternative treatments all over the world, patients' demands for alternative treatments are increasing.
What are the practical recommendations to prevent the recurrence of ingrown hair?
– Patients should have cleaning and dressing as recommended by the physician
– After the wound or hair entry holes are healed, the coccyx groove should be washed and wiped every day to remove stray hairs.
– Very hairy. Those who have this problem should clean the coccyx groove once a week with hair removal cream or tweezers and shave their buttocks widely.
– Removing hair with laser after local treatment or surgery is the most effective measure to prevent recurrence.
Are there any side effects of local treatments for ingrown hair?
Phenol and silver nitrate in the treatment of ingrown hair; It does not cause side effects as long as it does not escape outside the labyrinth, but if it escapes outside the labyrinth and causes pain and discharge in the same place within a few days, its treatment is provided by dressing under local anesthesia.
What are the features of local treatment for ingrown hair?
– It does not require general anesthesia
– It is a small procedure that can be performed under office conditions
– It does not require bed rest after the procedure and there is no delay from work
– It has a low recurrence rate and if it recurs, it is treated with the same method.
– There is very little incision scarring, no cosmetic problems.
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