Pilonidal sinus disease (ingrown hair) in children:

Although pilonidal sinus is most commonly seen in the sacrococcygeal region (coccyx), it can occur in any area of ​​the body where hair can enter. Although it was thought to be congenital in the past, it has been accepted as an acquired skin disease since 1946. Because pilonidal sinus is thought to be a chronic foreign body reaction, formed by the penetration of thin, tight and hard hairs. While the surrounding hairs entering the skin are not separated from their roots, they begin to form sinuses and form a short channel. The abscess formed as a result of the infection here usually opens to the skin through a canal located laterally on the sacrum. Then, a channel extending to the sinus tract is formed

It is more common in whom and at what ages

Sacrococcygeal pilonidal sinus is more common in young adults, especially in men. Although pilonidal sinus disease peaks between the ages of 16-25, it can be seen at any age, and its incidence gradually decreases after the age of 25. The fact that it is more common in men, under the age of 40, and especially in professional groups such as drivers, soldiers and students supports the hypothesis that the disease develops with the contribution of factors such as hair density and local microtrauma, as well as hormonal predisposition. The fact that it is also seen in other folds of the body, such as the axilla, inguinal region, umbilicus, neck and even between the fingers, highlights the local microtrauma factor. As a matter of fact, while the disease is also seen in women, it may not be seen in every extremely hairy man.

Clinical

Pilo The most common symptom of nidal sinus disease is 3-5 cm deep swelling of the anus. It is the presence of one or more sinus mouths (pits) above and in the sacrococcygeal area. A thin, soft hairball may be observed coming out of the sinus mouth. Due to its proximity to the anal area, the risk of infection is high. Clinically, discomfort, distension, and often mucoid discharge are present. Abscess symptoms are classic. A trauma may lead to the onset of symptoms.

The following findings may be observed as a result of physical examination: Edema or nodule in the coccyx, midline, fluctuation, purulent discharge from one or more lesions, tenderness on palpation, temperature increase, induration and/or cellulitis (usually minimal). In chronic or recurrent disease, visible or palpable ducts 2-5 cm long, rarely fever, tenderness on rectal examination and/or absence of fluctuation.

The clinical course of the disease is examined in 4 parts:

Risk factors for Pilonidal Sinus Disease:

• Male gender
• Familial predisposition
• Obesity
• Sedentary lifestyle (not doing sports, constantly sitting in front of the computer)
• Repetitive trauma
• Professions that require sitting for long periods of time

Clinical Classification of Patients:

• Type 1: These patients have no previous history of discharge or abscess, and they generally do not require treatment. Personal hygiene rules (frequent bathing, clean and cotton underwear, wide and comfortable trousers and avoiding sitting for long periods of time) and local hair removal (epilation) are recommended for these patients.
• Type 2: Acute pilonidal abscess has developed. These abscesses should be drained with a lateral incision and the hairs should be cleaned. Treatment is continued with frequent dressings and oral first- or second-generation safelosporins or sulbactam-ampicillin. They require definitive surgical treatment after the abscess is resolved.
• Type 3: These are cases that manifest themselves with pits within the borders of the coccyx region with a previous history of abscess drainage or discharge. If there is no inflammation, surgical treatment can be applied. These patients should first undergo surgery to remove the chronically inflamed sinus and clean the hair as much as possible, and then after the symptoms subside.
• Type 4: The coccyx region of one or more sinuses. are phenomena that are outside its borders. Again, in these patients, there may be active inflammation in some sinus openings. The history of these patients includes many episodes of abscess formation, drainage and discharge. Treatment in this case is two-stage surgery. Detailed MRI examination is very useful in cases where differential diagnosis is difficult.
• Type 5: Pilonidal sin� These are the cases that developed recurrence after abdominal surgery. The biggest reason for the failure of the previous attempt is the re-formation of the intergluteal sulcus over time due to the failure to determine the sinus width in the patient's coccyx region correctly. In this regard, in the first attempt, the sinus region boundaries must be determined correctly and lateralization and sulcus flattening must be done in accordance with the patient's anatomy.