Pilonidal Sinus: Dermatologist Dr. Kasten on Causes, Diagnosis, and SiLaC Laser Therapy

Dr. med. Robert Kasten is a specialist in dermatology and has been running his dermatological practice in Mainz since 2006. As an experienced dermatologist, he specializes in various procedures in this field. His wide range of treatments has included the SiLaC laser therapy by biolitec for many years, which is used to treat pilonidal cysts.

Dr. Kasten, what exactly is a pilonidal cyst and how does it develop?

A pilonidal cyst is a chronic inflammation in the gluteal cleft. It is caused by ingrown hairs that lead to a foreign body reaction. Cavities form under the skin, from which unpleasant-smelling discharge emerges.

The term pilonidal cyst is actually incorrect, as the inflammation is primarily located over the sacrum and not over the coccyx. Additionally, the fistula tracts do not connect to the bone. More appropriate terms are “pilonidal sinus” or “sinus pilonidalis.” These terms acknowledge that ingrown hairs (Latin: pilus for hair and nidus for nest) are responsible for the condition.

Are there certain risk factors that favor this condition?

The condition primarily affects younger men who have thicker body hair and sweat more. Prolonged sitting can also promote the occurrence of a pilonidal sinus.

What symptoms might indicate to me as a patient that I could have a pilonidal cyst?

Our patients often notice moisture in the gluteal cleft, which may show as stains on their underwear. Some also notice an unpleasant odor. Painful inflammations with swelling and abscess formation in the gluteal cleft are not uncommon.

How do you diagnose a pilonidal cyst? Are there specific procedures for this?

A pilonidal cyst can usually be diagnosed clinically. With a special magnifying glass, the dermatoscope, one can identify the so-called “pits.” The pits are the openings of the fistula tracts to the surface. Sometimes “proud flesh” forms around the pits, which is a reddish, moist, raised granulation (new tissue that forms during the wound healing process). In special cases, an ultrasound examination or an MRI may be necessary. These examinations are painless. As part of the treatment, the extent of the fistula tracts is examined with a probe. This is done under local anesthesia.

Does a pilonidal cyst always need to be treated, or can it heal on its own?

A pilonidal cyst almost never heals on its own because the tracts and cavities are lined with so-called epithelial tissue, which prevents closure, and there are also hairs under the skin. For a pilonidal sinus to heal, the hairs and epithelium must be removed. Additionally, permanent hair removal with laser or IPL is necessary to reduce the risk of recurrence. If an inflamed pilonidal sinus persists for many years, a squamous cell carcinoma can even rarely develop.

What treatment options do I have as a patient?

Self-treatment of a pilonidal sinus is unfortunately not possible. However, a specialized doctor can usually help and provide relief from this burdensome condition. Nowadays, minimally invasive therapies are available that allow a quick return to everyday life. These include pit-picking, where the fistula openings are removed, and the ablation of the epithelium of the fistula tracts and cavities with a laser.

How does the SiLaC laser therapy work and what are its special features?

In laser treatment, the fistula tracts are ablated so that the tracts and cavities can close. Beforehand, we clean the duct systems of hairs and inflamed tissue. Healthy skin and unaffected subcutaneous tissue are preserved, allowing a very quick return to everyday activities. This method can be repeated multiple times if necessary. Additionally, permanent hair removal with laser or IPL should definitely be performed to prevent hairs from growing back into the gluteal cleft.

How long does the treatment take and when can one return to normal activities?

The treatment generally takes between 30 to 45 minutes and is performed under local anesthesia. When one can return to normal activities depends, of course, on the severity of the condition and the extent of the therapy. Most patients can shower again the day after the surgery. Swimming pools, sports, and saunas should be avoided for about 2 weeks. It may take several weeks for the wounds to completely heal. If moisture in the gluteal cleft persists after 6 weeks, further laser therapy may be necessary.