Dermatológia pre prax 2/2026
Pilonidal sinus – dermatological and surgical problem
Introduction: The article aims to draw the attention of dermatologists to a separate nosological unit of sinus pilonidalis (SP), inflammation of the skin of the intergluteal (IG) cleft. Causal dermatological treatment of SP in the early stages will prevent the development of subcutaneous abscesses and fistulas, which must be treated surgically. Surgical treatment should be outpatient and minimally invasive. After each surgical treatment, repeated outpatient dermatological care of the skin of the IG cleft is necessary, which will prevent the development of sinus pilonidalis recidivans (SPR).
Material and method: From June 2004 to April 2026, 437 patients with SP/SPR were treated surgically on an outpatient basis. 136 (32%) patients with pilonidal abscess and 313 (68%) patients with chronic fistula. 382 (87%) patients with a diagnosis of primary SP and 55 (13%) patients with a diagnosis of SPR after conventional invasive excision(s). An outpatient treatment method with a cutting elastic ligature was used in all of them. The simplest minimally invasive surgical procedure under local anesthesia for the definitive cure of SP/SPR without excision of healthy skin and subcutaneous tissue.
Results: The treatment process of primary SP lasted an average of 8 weeks, for SPR 12 weeks. The postoperative follow-up interval was 3 years. In the group of 437 patients, 27 patients (6%) had a recurrence, in the interval of 6 months to 8 years from the cure of primary SP. 21 of them were cured again with elastic ligation. Definitively cured SP/SPR with elastic ligation, including 21 cured recurrences, were 431 patients (98% ).
Conclusion: The absence of causal dermatological treatment of SP leads to purulent complications, which are the subject of surgical treatment. The surgical method of cutting elastic ligature is individualized, it definitively cures SP/SPR, without hospitalization and invasive excision, outpatiently, without interruption of work, with minimal discomfort. From the point of view of preventing the occurrence of SPR, postoperative dermatological care, including laser epilation, is essential for the patient.
Keywords: pilonidal sinus, outpatient dermatological and surgical treatment, cutting elastic ligature, laser epilation
