Pilonidal Sinus Disease is Associated with Severe Hidradenitis Suppurativa in a Spanish Cohort.

Hidradenitis suppurativa is a chronic inflammatory disorder of the hair follicle with a high level of morbidity. Pilonidal sinus disease is a comorbid disorder and may be the reason for first contact with the healthcare system of patients with hidradenitis suppurativa. The aim of this study was to evaluate the frequency of association of pilonidal sinus disease and hidradenitis suppurativa and to explore whether pilonidal sinus disease defines a different clinical profile for patients with hidradenitis suppurativa. A cross-sectional study in which data regarding past history of pilonidal sinus disease, clinical and sociodemographic information were recorded during the first visit to the Hidradenitis Suppurativa Clinic of 2 tertiary hospitals. A total of 839 patients were included in the study. Of these, 51.7% (434/839) were male and mean age was 37.3 ± 13.6 years. Pilonidal sinus disease was present in 32.6% (269/839) of the patients and was associated with an early debut of hidradenitis suppurativa, a higher Hurley stage, inflammatory phenotype and a greater number of fistulas and perianal involvement. Elapsed time between pilonidal sinus disease and diagnosis of hidradenitis suppurativa was associated with higher disease severity. Pilonidal sinus disease is a frequent comorbidity and risk marker for hidradenitis suppurativa disease severity. Pilonidal sinus disease could be a sentinel event to identify patients who would benefit from close treatment and follow-up.

Demographic overview of pilonidal sinus carcinoma: updated insights into the incidence.

PURPOSE: There are only rough estimates of the worldwide incidence of pilonidal sinus carcinoma. The purpose of the study is to explore the demographic characteristics of this disease and to provide more precise information about its incidence. METHODS: The study included questioning the surgeons and pathologists in Germany in addition to a literature research. The literature investigation included all published articles about pilonidal carcinoma in all languages. The questionnaire included 1050 pathologists and all 834 hospitals with a surgical division in Germany. The outcome measures included the total number of cases, the language of publication, gender, age, country of origin, interval until the diagnosis of carcinoma, and reported incidence based on local studies. RESULTS: From 1900 to 2022, we found 140 cases of pilonidal sinus carcinoma in 103 articles. The investigation revealed two additional unpublished cases from Germany. The male-to-female ratio was 7.75:1. The countries with the most cases were the USA (35 cases, 25.0%), Spain (13 cases, 9.3%), and Turkey (11 cases, 7.6%). The average age was 54.0 ± 11.8 years and the interval between the diagnosis of the disease and the development of carcinoma was 20.1 ± 14.1 years. There was a parallel increase in reported cases of pilonidal sinus disease and pilonidal carcinoma over the last century. The reported incidence varied from 0.03% to 5.56%. The worldwide calculated incidence equaled 0.17%. CONCLUSION: Due to underreporting and other causes, the incidence of carcinoma emerging on the background of pilonidal sinus disease is higher than reported.

Is Polycystic Ovary Syndrome a Predisposing Factor for Pilonidal Sinus Disease?

BACKGROUND: The incidence of pilonidal sinus may be increased in women with polycystic ovary syndrome. OBJECTIVE: This study aimed to compare the prevalence and risk factors of pilonidal sinus disease in women with and without polycystic ovary syndrome in the same population. DESIGN: This was a case-control study. SETTINGS: This study was conducted in a Turkish rural district state hospital. PATIENTS: This study included 40 female patients with polycystic ovary syndrome and 120 female patients without polycystic ovary syndrome. MAIN OUTCOME MEASURES: The prevalence of pilonidal sinus, age, BMI, number of baths per week, daily sitting time, and family history of pilonidal sinus were recorded. RESULTS: Pilonidal sinus was detected in 22.5% (12.5% asymptomatic pits, 10% symptomatic) of patients with polycystic ovary syndrome and 1.7% of the control group ( p < 0.001). No difference was noted between the 2 groups in terms of BMI ( p = 0.219). Family history was similar between the case and control groups ( p = 0.520). No significant difference was noted between the 2 groups in terms of insufficient hygiene and daily sitting time ( p = 0.763, p = 0.706). Multivariate analysis showed that the risk of pilonidal sinus was significantly higher in patients with a positive family history ( p = 0.008). LIMITATIONS: The number of patients in the case and control groups in the study was limited. In addition, the control group may not fully reflect the general population because it was composed of only patients who presented to the general surgery and gynecology outpatient clinic for other reasons. The control group was not age matched. CONCLUSIONS: In our study, we found that the prevalence of pilonidal sinus was significantly higher in patients with polycystic ovary syndrome. See Video Abstract at http://links.lww.com/DCR/B945 . ES EL SNDROME DE OVARIO POLIQUSTICO UN FACTOR PREDISPONENTE PARA LA ENFERMEDAD DEL SENO PILONIDAL: ANTECEDENTES:La incidencia de enfermedad del seno pilonidal puede aumentar en mujeres con síndrome de ovario poliquístico.OBJETIVO:El objetivo fue comparar la prevalencia y los factores de riesgo de la enfermedad del seno pilonidal en una misma poblacion de mujeres con y sin síndrome de ovario poliquístico.DISEÑO:Este fue un estudio de casos y controles.ENTORNO CLÍNICO:Se llevó a cabo en un hospital estatal de un distrito rural turco.PACIENTES:Este estudio incluyó a 40 pacientes mujeres con síndrome de ovario poliquístico y 120 pacientes mujeres sin síndrome de ovario poliquístico.PRINCIPALES MEDIDAS DE VALORACIÓN:Se registraron la prevalencia del seno pilonidal, la edad, el IMC, el número de duchas por semana, el tiempo diario para sentarse y los antecedentes familiares de seno pilonidal.RESULTADOS:El seno pilonidal se detectó en el 22,5 % (12,5 % fosas asintomáticas, 10 % sintomáticas) de las pacientes con síndrome de ovario poliquístico y en el 1,7 % del grupo control ( p < 0,001). No se observaron diferencias entre los dos grupos en términos de IMC ( p = 0,219). Los antecedentes familiares fueron similares entre los grupos de casos y controles ( p = 0,520). No se observaron diferencias significativas entre los dos grupos en términos de higiene insuficiente y tiempo de sedentarismo diario ( p = 0,763, p = 0,706). El análisis multivariante mostró que el riesgo de seno pilonidal fue significativamente mayor en pacientes con antecedentes familiares positivos ( p = 0,008).LIMITACIONES:El número de pacientes en los grupos de casos y controles en el estudio fue limitado. Además, es posible que el grupo de control no refleje completamente a la población general, ya que está compuesto solo por pacientes que acudieron a la consulta externa de cirugía general y ginecología por otras razones. El grupo de control no fue emparejado por edad.CONCLUSIONES:En nuestro estudio encontramos que la prevalencia de seno pilonidal fue significativamente mayor en pacientes con síndrome de ovario poliquístico. Consulte Video Resumen en http://links.lww.com/DCR/B945 . (Traducción-Dr. Ingrid Melo ).

Risk factors for recurrence after pilonidal sinus surgery in children and adolescents.

BACKGROUND: Acquired pilonidal sinus disease (PSD) is a condition involving hair bundles most commonly located in the midline of the sacrococcygeal region. The aim of this study is to investigate the risk factors for recurrence after the surgical treatment of PSD in children and adolescents. METHODS: This retrospective study was conducted with patients who underwent surgery for PDS at the Paediatric Surgery Clinic of Karaman State Hospital between July 2010 and December 2018. Age, gender, weight, and height of the patients were recorded. Whether or not there was a recurrence after the surgery as well as the factors affecting recurrence in the cases with recurrence were examined. RESULTS: A total of 86 PSD patients were included in the study. Of these, 36 (41.9%) were girls and 50 (58.1%) were boys. The mean follow-up period was 15.1 ± 8.4 months. Their mean age was 15.16 ± 1.29 years. Postoperative recurrence developed in 14 patients (16.3%). Postoperative recurrence was significantly higher in those who were overweight than in those of normal weight (p < 0.001) and in females when compared to males (p = 0.014). Gender and BMI were interrelated as risk factors. The effect of female gender on the likelihood of recurrence was threefold that of BMI. CONCLUSION: It was observed in this study that female gender and a high BMI significantly increased the risk of PSD recurrence after surgery.

Endoscopic pilonidal sinus treatment (EPSiT) in the pediatric age group: Short-term results.

BACKGROUND: This study aims to evaluate the short term outcomes of the Endoscopic pilonidal sinus treatment (EPSiT) in the pediatric age group. METHODS: In this study, between June 2018 and July 2019, pediatric patients with pilonidal sinus (PS) who were treated with the EPSiT method were reviewed retrospectively. RESULTS: Of the twenty-nine patients (20 males, nine females), the average age was 15.5±2.8 years, and the average body mass index (BMI) was 25.8±4.2. Eight patients (28%) presented with a history of recurrence following the previous surgery. The average number of fistulas present in cases was 1.17 (1-2). The localization of the fistula was midline in twenty-four and lateral in five of the patients. The average time of the EPSiT procedure was 57±13.9 minutes, and the average time of hospital stay was 11.4±7.2 hours. The pain score average was 0.86 (range of 0-3) and the duration of analgesic use was 37 hr (12-72 hr). The mean post-operative time of total wound healing was 18.71 days (7-60 days) for primary presenting cases. Early wound healing was seen in twenty-five patients (average of 14 days), while late wound healing was observed in four patients (average of 60 days). The mean time of follow-up was 8.3±3.34 months. The average time of return to full daily activity was 2.1 days (0-30 days), while it was the same day for sixteen (53%) patients. In post-operative follow-up, early (bleeding: 1) and late (formation of granulation tissue: 1, recurrence: 8) complications were seen in nine patients. Of the eight patients (27.5%) whose recurrence was detected, seven were primary and one was secondary presenting patients. The average time of presentation for recurrence was 5.8 mo (1-10 mo). Re-EPSiT was applied in two of the eight patients with recurrence and is planned for five, while one of the patients lost to follow-up. CONCLUSION: EPSiT is an easily applicable, pain-free minimal invasive procedure with a short period of hospital stay and a fast return to routine daily activity. It provides comfortable and repeatable intervention in cases with recurrences after the EPSiT procedure and other methods for PS treatment.

Pilonidal sinus disease recurrence at a tertiary care center in Riyadh.

BACKGROUND: Pilonidal sinus disease (PSD) is a chronic inflammatory disease of the sacrococcygeal area. Pilonidal sinus recurrence is a matter of concern to both patients and healthcare providers. OBJECTIVES: Estimate the rate of PSD recurrence in our center and identify any risk factors contributing to disease recurrence. DESIGN: Retrospective. SETTING: Tertiary care center in Riyadh. PATIENTS AND METHODS: All patients who underwent surgery for primary or recurrent pilonidal sinus between 1 January 2016 to 30 June 2019 were included to allow for at least 1-year of follow-up at the time of data collection. MAIN OUTCOME MEASURE: Recurrence rate of PSD and risk factors for recurrence. SAMPLE SIZE AND CHARACTERISTICS: 369 patients: 329 males (89.2%) and 40 (10.8%) females. Median (interquartile range) age was 21 (18-26) years. RESULTS: Of the 369 included patients, recurrence was identified in 84 (22.8%) cases [95% confidence interval (CI) 18.6-27.4], and the mean timing of recurrence was 1.8 (1.6) years after the primary surgery. In a multivariate logistic regression analysis, increased age and post-operative seroma fluid discharge were independent risk factors for recurrence. In contrast, preoperative antibiotic prophylaxis and postoperative hair removal were effective in reducing recurrence. Type of surgery closure had no effect on recurrence, yet primary closure was associated with early onset of recurrence compared to secondary closure (P=.02). CONCLUSION: Our findings on the factors associated with recurrence of PSD are consistent with many reports in the literature. Reported prevalence estimates vary widely. LIMITATION: Single center, small sample size, retrospective. CONFLICT OF INTEREST: None.

Gender-specific prevalence of pilonidal sinus disease over time: A systematic review and meta-analysis.

BACKGROUND: Gender-specific risk factors have been suggested to promote a fourfold higher incidence of pilonidal sinus disease (PSD) in male as compared to female patients. However, in recent decades there has been an apparent shift towards an increasing prevalence of PSD in women, as body weight and other risk factors influence the disease. We aimed at determining whether PSD prevalence actually changed in men and women over time. METHODS: Following PRISMA guidelines (PROSPERO ID: 42016051588), databases were systematically searched. Papers reporting on PSD published between 1833 and 2018 in English, French, German, Italian and Spanish containing precise numbers of male and female participants were selected for analysis. Gender-specific prevalence of PSD over several decades was the main outcome measure. RESULTS: We screened 679 studies reporting on 104 055 patients and found that the male/female ratio in patients with PSD has remained constant over time, with women being affected in about 20% of all PSD cases (I2  = 96.18%; meta-regression p < 0.001). CONCLUSION: While the prevalence of PSD has risen over the past decades, the ratio between affected males and affected females has remained constant, with women invariably representing about 20% of patients despite wide ranging socioeconomic and behavioural changes.

Pilonidal sinus disease on the rise: a one-third incidence increase in inpatients in 13 years with substantial regional variation in Germany.

PURPOSE: Collective evidence from single-centre studies suggests an increasing incidence of pilonidal sinus disease in the last decades, but population-based data is scarce. METHODS: We analysed administrative case-based principal diagnoses of pilonidal sinus disease and its surgical therapy between 2005 and 2017 in inpatients. Changes were addressed via linear regression. RESULTS: The mean rate of inpatient episodes of pilonidal sinus disease per 100,000 men increased from 43 in 2005 to 56 in 2017. In females, the mean rate of inpatient episodes per 100,000 women rose from 14 in 2005 to 18 in 2017. In the whole population, for every case per 100,000 females, there were 3.1 cases per 100,000 males, but the numbers were highly variable between the age groups. There was considerable regional variation within Germany. Rates of inpatient episodes of pilonidal sinus disease were increasing in almost all age groups and both sexes by almost a third. Surgery was dominated by excision of pilonidal sinus without reconstructive procedures, such as flaps, whose share was around 13% of all procedures, despite recommendations of the national guidelines to prefer flap procedures. CONCLUSION: Rates of inpatient episodes of pilonidal sinus disease in Germany rose across almost all age groups and both sexes with relevant regional variation. The underlying causative factors are unknown. Thus, patient-centred research is necessary to explore them. This should also take cases into account that are solely treated office-based in order to obtain a full-spectrum view of pilonidal sinus disease incidence rates.

Isotretinoin in the treatment of hidradenitis suppurativa: a retrospective study.

OBJECTIVE: Isotretinoin has been used off-label in hidradenitis suppurativa (HS) patients with variable results, making it difficult to predict which patients with HS are likely to benefit. MATERIAL AND METHODS: We conducted a retrospective review of HS patients who presented to UCLA HS clinic between August 2009 and March 2018 and collected data on their demographics, reported history of isotretinoin treatment for HS, and treatment response. A number of patient variables were analyzed between the responders and non-responders to see if any were associated with a higher likelihood of a beneficial response. RESULTS: Of the 209 patients, 39 (18.7%) reported prior treatment with isotretinoin. A beneficial response to isotretinoin was reported by 14 (35.9%) patients, while 25 (64.1%) patients reported no response. When comparing responders to non-responders, responders were more likely to have a history of pilonidal cyst (p = .024). Having a concomitant history of regular or cystic acne did not appear to enhance HS treatment response to isotretinoin. CONCLUSIONS: Our data suggest that for HS patients, having a history of pilonidal cyst is associated with a beneficial response to isotretinoin.

Global Gender Differences in Pilonidal Sinus Disease: A Random-Effects Meta-Analysis.

BACKGROUND: Pilonidal sinus disease (PSD) is traditionally associated with young male patients. While PSD is rare in Asia and Africa, lifestyles are changing considerably throughout the so-called developed world. We question that PSD is an overwhelmingly male disease and that the proportion of women suffering from PSD is worldwide evenly distributed in a homogenous matter. METHODS: We analysed the world literature published between 1833 and 2018, expanding on the database created by Stauffer et al. Following correction for gender bias with elimination of men-only and women-only studies, data were processed using random-effects meta-analysis in the technique of DerSimonian and Laird. RESULTS: The share of female pilonidal sinus disease patients analysed from all studies available in the world literature is 21%. There are marked regional differences including South America (39%), North America as well as Australia/New Zealand (29%) and Asia (7%), which are highly significant. These results stand fast even if analysis without gender bias corrections was applied. CONCLUSION: The share of female patients suffering from PSD is considerable. It is time to think of PSD as a disease of both men and women. Previously unknown, there are significant regional differences worldwide; the reason(s) for the regional differences is still unclear.

Clinical characteristics of pediatric hidradenitis suppurativa: a cross-sectional multicenter study of 140 patients.

Hidradenitis suppurativa (HS) rarely affects pediatric patients. The literature on pediatric HS patients is scarce. This is a cross-sectional study based on case note review or interviews and clinical examination of 140 pediatric patients undergoing secondary or tertiary level care. Patients were predominantly female (75.5%, n = 105) with a median age of 16. 39% reported 1st-degree relative with HS. Median BMI percentile was 88, and 11% were smokers (n = 15). Median modified Sartorius score was 8.5. Notable comorbidities found were acne (32.8%, n = 45), hirsutism (19.3%, n = 27), and pilonidal cysts (16.4%, n = 23). Resorcinol (n = 27) and clindamycin (n = 25) were the most frequently used topical treatments. Patients were treated with tetracycline (n = 32), or oral clindamycin and rifampicin in combination (n = 29). Surgical excision was performed in 18 patients, deroofing in five and incision in seven patients. Obesity seemed to be prominent in the pediatric population and correlated to parent BMI, suggesting a potential for preventive measures for the family. Disease management appeared to be similar to that of adult HS, bearing in mind that the younger the patient, the milder the disease in majority of cases.

Reparación plástica con colgajo de Limberg en seno pilonidal sacrococcigeo / Plastic repair with Limberg flap in sacrococcygeal pilonidal sinus

En este trabajo se presenta la técnica quirúrgica descrip-ta por Limberg para las reparaciones plásticas, su uso para el tratamiento del seno pilonidal sacro coccígeo junto con sus resultados, tasas de éxito, complicaciones y recaídas. Para ello se realizó una búsqueda bibliográfica sobre el tema y se analizaron los resultados para determinar con-clusiones sobre la misma.La elección del tema la realicé en base a mi interés sobre la patología. El mismo surge a partir de mi observación en la práctica clínica de pacientes sometidos a técnicas no resectivas, abiertas, con una alta tasa de lechos cruentos, cicatrizaciones lentas y recaídas que podrían beneficiar-se de los principios que la reparación de Limberg ofrece. La técnica se describe como algo simple y fácilmente re-producible mientras se respeten sus principios, lo cual la vuelve una opción viable y atractiva. Lo antedicho sumado al respaldo bibliográfico hallado han sido los motores de la investigación actual.

Impact of geography and surgical approach on recurrence in global pilonidal sinus disease.

Pilonidal sinus disease (PSD) is increasing globally. A recent meta-analysis and merged-data analysis showed that recurrence rates in PSD depend essentially on follow-up time and specific surgical procedures. However, the global distribution of surgical approaches and respective recurrence rates have never been studied in PSD. We aimed at studying the impact of geographic distribution of surgical approaches to treat PSD and subsequent geography-specific recurrence rates. We searched relevant databases as described previously. Recurrence rates were then associated with reported follow-up times and geographic origin. We simulated individual patients to enable analogy across data. Globally, recurrence rates range from 0.3% for Limberg/Dufourmentel approaches (95% CI 0.2-0.4) and flaps (95% CI 0.1-0.5) and up to 6.3% for incision (95% CI 3.2-9.3) at 12 months. Recurrence rates range from 0.3% for Karydakis/Bascom approaches (95% CI 0.0-0.8) up to 67.2% for incision (95% CI 7.5-100) in the USA, and 0.0% for primary asymmetric closure in Germany (95% CI 0.0-0.0). Our analysis shows that recurrence rates in PSD not only depend on therapeutic approaches and follow-up time but also on geography. Primary asymmetric closure and various flap techniques remain superior regardless of the geographical region. Some approaches have extraordinarily good outcomes in specific countries.

Anal fistula and pilonidal sinus disease coexisting simultaneously: An audit in a cohort of 1284 patients.

Fistula-in-ano and pilonidal disease are not known to occur together. In a retrospective study, all patients having fistula-pilonidal disease coexisting simultaneously were included. Out of 1284 patients, 933 were operated (fistula-in-ano, 849; pilonidal disease, 77; and coexisting fistula-pilonidal, 7). A total of 351 patients did not undergo any surgery (two patients had coexisting fistula-pilonidal). Thus, a total of nine patients having coexisting fistula-pilonidal sinus were included in the study (mean age 35.8 ± 19.9 years, M/F 7/2). pIn 6/9 patients, the pilonidal tract was communicating with fistula-in-ano, and in 3/9 patients, they were not communicating/connected. The connection could be established preoperatively with the help of MRI. In all patients with communicating fistula-pilonidal sinus (n=6), the fistula was posterior. 6/9 patients had recurrent fistula and all (9/9) had multiple tracts. The fistula was high and complex in 8/9 patients (grade IV-7, grade V-1). 4/9 patients tested positive for tuberculosis while one patient was suffering from hidradenitis suppurativa. The latter improved on medical treatment. One patient did not agree for surgery and seven were operated. The disease healed in four patients, the disease did not heal in one patient, and two patients were in the convalescent stage. Anal fistula and pilonidal disease can coexist in a same patient and can even be connected. Such diseases are more complex and have a higher incidence of associated diseases like tuberculosis. Magnetic resonance imaging plays a pivotal role in diagnosis. If the connection is missed, the disease treatment becomes difficult.

Pilonidal sinus disease: an intergluteal localization of hidradenitis suppurativa/acne inversa: a cross-sectional study among 2465 patients.

BACKGROUND: Hidradenitis suppurativa (HS), also referred to as acne inversa, is a debilitating skin disease characterized by inflammatory nodules, chronic abscesses and tunnels (fistulae and sinuses). The association with pilonidal sinus disease (PSD) is frequently reported but not well documented. OBJECTIVES: To determine the prevalence and characteristics of inflammatory skin lesions located in the intergluteal fold (IGF) of patients with HS. METHODS: This was an international multicentre retrospective cross-sectional study based on data collection from a large cohort of patients with HS with and without histopathology. Results From a total of 2465 patients with HS included in the study, 661 (27%) reported lesions in the IGF. These patients were significantly more often smokers and had more severe HS. Of the 238 patients with an available clinical diagnosis, intergluteal-HS (IG-HS) was diagnosed in 52 patients (22%) and PSD was diagnosed in 186 patients (78%). IG-HS was associated with the localization of HS in the proximity of the IGF, including the buttocks, genitals and the anus. There was a possibility of misclassification bias in this study as a clinical/image-based diagnosis or histopathology of the IGF lesions was not always available. CONCLUSIONS: The high prevalence of PSD suggests a strong link between both entities. Therefore, it may be useful to identify common pathophysiological mechanisms and develop common therapeutic strategies. What's already known about this topic? The occurrence of pilonidal sinus disease has not been clearly reported among patients with hidradenitis suppurativa/acne inversa. What does this study add? This is the first study that investigated the prevalence of pilonidal sinus disease among a large cohort of patients and identified the patient characteristics. Risk factors that might help to improve the management of patients were identified.