Rethinking the causes of pilonidal sinus disease: a matched cohort study

Area of Science:

• Medical Science
• Dermatology
• Surgical Pathology

Background:

• The prevailing theory suggests hair penetration of wet skin promotes pilonidal sinus disease (PSD).
• This assumption, established 29 years ago, has not been empirically validated.
• The role of sweating in PSD pathogenesis remains unproven.

Purpose of the Study:

• To investigate the relationship between sweating and pilonidal sinus disease (PSD).
• To challenge the traditional view of sweating as a risk factor for PSD.
• To assess sweat production in PSD patients compared to a control group.

Main Methods:

• Pilocarpine iontophoresis was used to stimulate and measure sweat production in the glabella sacralis.
• 100 patients diagnosed with PSD were matched with 100 controls based on sex, age, and BMI.
• Sweat was collected for 15 minutes following a 5-minute pilocarpine iontophoresis procedure.

Main Results:

• Pilonidal sinus disease (PSD) patients exhibited significantly lower sweat production (18.4 ± 1.6 µl) compared to controls (24.2 ± 2.1 µl, p=0.03).
• Men consistently produced more sweat than women across both PSD and control groups.
• Regular exercisers demonstrated higher sweat output than non-exercisers, irrespective of PSD status.

Conclusions:

• Pilonidal sinus disease (PSD) patients sweat less than their matched controls.
• The findings contradict the established postulate that sweating promotes PSD.
• Reduced sweating may be associated with pilonidal sinus disease, suggesting a potential protective role for sweat.