Etiologic factors in developing sacrococcygeal pilonidal sinus disease in males; A cased-control study

Two main theories have been proposed for the development of sacrococcygeal pilonidal sinus disease (SPSD), but the exact etiology remains unclear. Better understanding of etiologic factors could improve insight into the disease and help prevent both primary and recurrent pilonidal sinus disease. This study aimed to identify etiologic factors in the development of pilonidal sinus disease.

For this case control study, potential etiologic factors such as family history of SPSD, BMI, working in a sitting position, and smoking were evaluated in 83 patients with primary SPSD and 83 controls. Additionally, anatomical factors, including the depth, width, and hair density of the natal cleft were compared. Lastly, microscopic hair analysis assessed hair characteristics such as thickness, pigmentation, breakage, hair cuticle irregularities and hair thickness irregularities.

Patients with SPSD were significantly more often smokers and had a family history of SPSD. They also had a significantly shallower and wider natal cleft, a greater number of hairs in the natal cleft, and these hairs were significantly thicker with more cuticle and thickness irregularities compared to the controls. However, after multivariable analysis, only working in a sitting position, a shallower natal cleft and more hairs at the natal cleft were independently associated with SPSD.

A shallower natal cleft, more hair at the natal cleft and working in a sitting position were independent etiologic factors of SPSD. Therefore, keeping the natal cleft free of hair and avoiding prolonged sitting position should be recommended as preventive measures when counselling patients with SPSD.