Stop insulting the patient: neither incidence nor recurrence of pilonidal sinus disease is linked to personal hygiene.

  • Dietrich Doll Department of General and Visceral, Vascular and Paediatric Surgery, Saarland University, Homburg / Saar, Germany.
  • Markus M Markus M. Luedi Department of Anaesthesiology and Pain Medicine, Bern University Hospital Inselspital, Bern, Switzerland
  • Katharina Wieferich Vechtaer Institut für Forschungsförderung VIFF e.V., Vechta, Germany
  • Dominic van der Zypen Federal Social Insurance Office, Swiss Confederation, Bern, Switzerland
  • Matthias Maak Department of Surgery, University Hospital Erlangen of the Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
  • Matthias Glanemann Department of General and Visceral, Vascular and Paediatric Surgery, Saarland University, Homburg / Saar, Germany
Keywords: pilonidal disease, hygiene, surgery


INTRODUCTION: Pilonidal sinus disease (PSD) has been correlated with excessive sweating, exposure to adverse conditions such as military service, war, prolonged jeep driving, and also with inadequate personal hygiene. Aiming to destigmatise PSD, the purpose of this study was to shed light on the impact of obesity, sweating and chronically intermittent contamination of the rima ani, especially in the cohorts of extreme ages on the incidence and recurrence of PSD.
METHODS: Literature and epidemiological German data for the years 2000 to 2012 were reviewed and analysed. Pairwise comparisons were performed using the Wilcoxon rank sum test, median and mean values were supplemented with bootstrap confidence intervals. Cumulative abundances of explantations were fitted with a logistic model to compare the qualitative properties of individual methods.

RESULTS: Our investigation does not support an association between incidence and recurrence of PSD with exemplary measures of personal hygiene such as more often and longer contact of skin with sweat, faeces and urine in the intergluteal fold.

CONCLUSIONS: Neither urine or faecal contamination nor a potential increase in sweating due to higher BMI promote PSD incidence. The causative factors of pilonidal disease still remain incompletely understood till today. Patients who are blighted with PSD classically experience embarrassing recurrent infections before the disease is surgically cured; they should not be further insulted by emphasizing “maintaining exquisite personal hygiene” in the discharge letter. Recommending this is insulting and neither prevents the development of PSD nor its recurrence.


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