Categories
Ailmemts & Remedies

Pilonidal sinus

Alternative Names:pilonidal cyst, pilonidal abscess or sacrococcygeal fistula

Definition:
A pilonidal sinus is a dimple in the skin in the crease of your child’s buttocks.

This may be noted at birth as a depression or hairy dimple and be present for many years without any symptoms.
Pilonidal sinus affect men more often and most commonly occur in young adults.


You may click to see picture

Two pilonidal cysts in the natal cleft
A pilonidal sinus may also occur due to a blockage in the hair follicles, often associated with an ingrown hair.
In both situations, hair acts as a foreign body, which may produce an infection. The infection may spread into the tissues of your child’s buttocks and produce an abscess (collection of pus under the skin) at a site several inches away from the sinus.

Pilonidal means “nest of hair”, and is derived from the Latin words for hair (“pilus”) and nest (“nidus”).The term was used by Herbert Mayo as early as 1830. R.M. Hodges was the first to use the phrase “pilonidal cyst” to describe the condition in 1880.

Symptoms:
A pilonidal sinus may cause no noticeable symptoms (asymptomatic). The only sign of its presence may be a small pit on the surface of the skin.

When it’s infected, a pilonidal sinus becomes a swollen mass (abscess). Signs and symptoms of an infected pilonidal cyst include:

*Pain
*Localized swelling
*Reddening of the skin
*Drainage of pus or blood from an opening in the skin (pilonidal sinus)
*Foul smell from draining pus

Hair protruding from a passage (tract) below the surface of the skin that connects the infected pilonidal cyst to the opening on the skin’s surface (a pilonidal sinus) — more than one sinus tract may form
Fever (uncommon)

Causes:
Quite why it happens isn’t entirely clear. When they occur in the cleft between the buttocks, one popular explanation is that there’s a developmental defect in the direction that the hair grows – that is, the hair grows inwards rather than outwards.

One proposed cause of pilonidal cysts is ingrown hair. Excessive sitting is thought to predispose people to the condition because they increase pressure on the coccyx region. Trauma is not believed to cause a pilonidal cyst; however, such an event may result in inflammation of an existing cyst. However there are cases where this can occur months after a localized injury to the area. Some researchers have proposed that pilonidal cysts may be the result of a congenital pilonidal dimple. Excessive sweating can also contribute to the cause of a pilonidal cyst.

The condition was widespread in the United States Army during World War II. More than eighty thousand soldiers having the condition required hospitalization.  It was termed “jeep seat or “Jeep riders’ disease”, because a large portion of people who were being hospitalized for it rode in jeeps, and prolonged rides in the bumpy vehicles were believed to have caused the condition due to irritation and pressure on the coccyx.

Risk Factors:
Certain factors can make you more susceptible to developing pilonidal cysts. These include:

*Obesity
*Inactive lifestyle
*Occupation or sports requiring prolonged sitting
*Excess body hair
*Stiff or coarse hair
*Poor hygiene
*Excess sweating

Complications:
If a chronically infected pilonidal cyst isn’t treated properly, there may be an increased risk of developing a type of skin cancer called squamous cell carcinoma.

Differential diagnosis
A pilonidal sinus can resemble a dermoid cyst, a kind of teratoma (germ cell tumor). In particular, a pilonidal cyst in the gluteal cleft can resemble a sacrococcygeal teratoma. Correct diagnosis is important because all teratomas require complete surgical excision, if possible without any spillage, and consultation with an oncologist.

Treatment :
Treatment may include antibiotic therapy, hot compresses and application of depilatory creams.

In more severe cases, the cyst may need to be lanced or surgically excised (along with pilonidal sinus tracts). Post-surgical wound packing may be necessary, and packing typically must be replaced twice daily for 4 to 8 weeks. In some cases, one year may be required for complete granulation to occur. Sometimes the cyst is resolved via surgical marsupialization.

Surgeons can also excise the sinus and repair with a reconstructive flap technique, which is done under general anesthetic. This approach is mainly used for complicated or recurring pilonidal disease, leaves little scar tissue and flattens the region between the buttocks, reducing the risk of recurrence.

Picture of Pilonidal cyst two days after surgery.

A novel and less destructive treatment is scraping the tract out and filling it with fibrin glue. This has the advantage of causing much less pain than traditional surgical treatments and allowing return to normal activities after 1–2 days in most cases.

Pilonidal cysts recur and do so more frequently if the surgical wound is sutured in the midline, as opposed to away from the midline, which obliterates the natal cleft and removes the focus of shearing stress.

Prevention:
To prevent future pilonidal sinus from developing:

*Clean the area daily with glycerin soap, which tends to be less irritating. Rinse the area thoroughly to remove any soapy residue. Washing briskly with a washcloth helps keep the area free of hair accumulation.

*Keep the area clean and dry. Powders may help, but avoid using oils or herbal remedies.
Avoid sitting for long periods of time.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Pilonidal_sinus
http://www.mayoclinic.com/health/pilonidal-cyst/DS00747
http://www.bbc.co.uk/health/physical_health/conditions/pilonidalsinus.shtml
http://www.childrenshospital.org/az/Site923/mainpageS923P0.html

Enhanced by Zemanta
Categories
Ailmemts & Remedies Featured

Those Painful Sinuses

Doctors have a lot of work in the winter months with the low temperatures, the monsoon, and the festivals with smoky fireworks. Almost everyone complains of colds and “sinusitis”.

CLICK & SEE

We have four pairs of sinuses that drain into the nasal cavity: frontal above the nose, maxillary in the cheekbone area, ethmoidal at the roof of the nose and between the orbits of the eyes, and sphenoidal on the sides of the forehead near the corner of the eyes. Sinuses are present at birth and continue to grow and develop until adolescence. They are, in fact, useful as they contain air, which helps to modulate the pitch and timber of the voice. They also reduce the total weight of the skull, which would otherwise be composed of heavy solid bone. They are lined with mucous membranes similar to that in the nose.

Sinuses may become inflamed as a result of viral infections, which are likely to occur with seasonal changes. A “cold” causes the nose to clog up and the natural orifices through which secretions from the sinus drain get blocked. Acute allergies to pollen, smoke, room fresheners and mosquito repellents compound the blockage. As the membrane swells, it exudes mucoid secretions which fill the sinus.

The space in the sinus is limited on all sides by rigid bone, leaving no room for expansion. The typical throbbing headache develops, and worsens on changing positions as the mucous shifts around. These clogged secretions may become secondarily infected by bacteria.

Sinusitis produces a nasal block, a thick yellow or green discharge, a troublesome sleep-disturbing night cough, fever and swelling over the affected sinuses. It can also cause bad breath, which persists despite brushing the teeth or using mouthwashes.

Acute sinusitis can be completely cured in 30 days with treatment — adequate doses of appropriate antibiotics for 10-14 days. If the treatment is discontinued after a few doses as relief is obtained, the infection tends to recur.

Recurrent sinusitis occurs in cycles with at least a 10-day, symptom-free intervening period. It occurs when there is exposure to the allergen again and again, perpetuating a cycle of nose blocks, infections, treatment and relief.

Sinusitis is labelled as chronic only if it persists for more than 90 days. It can be caused by a variety of bacteria or even fungi. It is rare in normal healthy individuals unless there is an aggravating factor. Pus from an infected untreated tooth, particularly in the upper jaw, can burrow into the maxillary sinus.

Some people have a deviated nasal septum (the partition between the two halves of the nose is not straight). This can be present from birth. It may develop as a result of injury. The small openings draining the sinuses may become blocked by the bent nose. Allergies, which are untreated and chronic, can cause permanently swollen nasal mucosa. This can form grape-like swellings called polyps. Children sometimes insert stones, peas, erasers and other objects into their nose. They can remain wedged, unsuspected and undiagnosed, causing a permanent nose block and sinusitis. Swollen adenoids can also perpetuate sinusitis.

Treatment of sinusitis is likely to succeed only if the aggravating factors are removed. Drainage of the infected material also has to be facilitated. This can be done by using nasal drops. Saline nasal drops are the safest and can be used as often as required. Nasal drops containing chemicals like oxymetaxoline, xylometazoline or ephedrine should be used 3-4 times a day only for the first three to four days, if at all.

Although immediate relief is obtained, in the long run habituation occurs. The nose does not open up even when the drops are used.

Continuous use can also cause rebound congestion. If the nasal mucosa is permanently swollen because of chronic allergy, the newer, non-absorbed steroid nasal sprays are helpful. Steam inhalations and humidifiers also help with liquefaction of the secretions and drainage.

Pain over the sinuses, fever and headache all respond well to paracetemol, which is sold under a variety of trade names. The dose of paracetemol is 500mg three to four times a day for adults and 10-15mg/kg/dose for children.

Sinusitis because of allergy or a viral infection does not need antibiotics. Antbiotics should be used for bacterial infections. Eradication of an infection is difficult, as sinuses are closed spaces. Antibiotics have to be carefully selected and need to be given for 10-14 days for a complete cure. Immunisation covers two of the organisms (H. Influenza and pneumococcus) which can cause sinusitis. This means that children who have been completely immunised are unlikely to be infected by these organisms.

Decongestants and mucous liquefying agents are also helpful if used in addition to other medicines. Antihistamines are not useful, as they tend to dry up the secretions, making them sticky and adherent.

Sinusitis, allergies and respiratory ailments all decrease in frequency and intensity with regular aerobic exercise, like 40 minutes of jogging, swimming or running daily.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Sources: The Telegraph (Kolkata, India)

css.php