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What is PNS or Pilonidal Sinus disease?

A pilonidal cyst is an abnormal pocket in the skin that contains hair and skin debris. A pilonidal cyst is almost always located near the tailbone at the top of the cleft of the buttocks. Hair penetrates the skin and is embedded resulting in an extremely painful abscess that becomes Infected.

The PNS or pilonidal sinus occurring in the cleft of the buttocks contains dirt, hair and debris and can cause severe pain. PNS disease is a common complaint among young men from puberty to their thirties, and is especially common among hairy people. PNS develops due to prolonged sitting and has a tendency to recur.

Pilonidal Sinus Disease Treatment Kochi

Types of Pilonidal Sinus Disease or PNS

Acute pilonidal disease

  • Swelling and discomfort for many days
  • Severe pain during presentation
  • Overlying cellulitis with swelling in the midline cleft
  • Area is painful to touch

Chronic pilonidal disease

  • Chronic pain and discharge
  • Two-year history of PNS
  • Presence of multiple sinuses
  • Localized swelling and edema

Pilonidal Sinus Disease Causes and risk factors

  • There is no exact cause established for pilonidal cysts.
  • Loose hairs penetrating the skin are deemed as the primary cause
  • Friction and pressure that can force hair down into the skin are:
    • Skin rubbing against skin
    • Tight clothing
    • Bicycling
    • Sitting for prolonged periods or similar factors
  • The body recognizes the hair as a foreign substance and forms a cyst around it

Signs and symptoms of PNS infection

  • Swelling of the cyst
  • Sitting and standing cause pain
  • Skin is red in the area
  • Presence of soreness
  • Draining of pus or blood from the abscess
  • Emission of a foul odor
  • Protrusion of hair from the lesion
  • Formation of holes in the skin
  • Low-grade fever

Treatment for Pilonidal Sinus Disease or PNS at Jacob’s Hospital


  • Initial treatment for an infected pilonidal cyst:
    • Procedure is performed at the doctor’s office
    • Area is numbed with an anesthetic
    • A small incision is made to drain the cyst
    • Extensive Surgical Procedure is required only if cyst recurs
    • Post surgery:
      • Wound is left open
        • Dressing is placed
        • Healing of the wound is inside out
        • With this recurrence of the cyst is lower
      • Wound is sutured close
        • Shorter healing times
    • Post surgical wound care :
      • A detailed consultation is provided for change of dressings regularly
      • Shaving of surgical site to avoid hairs entering the wound
  • Asymptomatic PNS:
    • Meticulous depilation
    • Hygiene
  • Surgical intervention:
    • Incision and drainage:
      • Elliptical incision is made just off the midline
      • Entire wound cavity is packed
      • Dead and infected tissue is removed with curettage
    • Wide excision and healing:
      • Wide excision of the elliptical wedge of the skin and subcutaneous tissue
      • All inflamed tissue and debris are removed
      • Wound is granulated from the base
    • Excision and primary closure:
      • Lateral incision is made to drain and curette the chronic abscess
      • Abscess cavity wall opposite to the incision is raised
      • The communication between the abscess cavity and midline pit is closed

Dr. Zubin Jacob at Jacobs Hospital, Kochi prescribes broad spectrum antibiotics for early onset of PNS if the patient does not experience severe pain. When conservative and medical management does not heal the sinus tract, he recommends surgical intervention as a cure.

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