Case Report: Eyebrow pilonidal sinus with bridging scar

Pilonidal sinus is an acquired inflammatory disease associated with trauma and subcutaneous hair implantation, most commonly occurring in the sacrococcygeal region. Facial pilonidal sinus is extremely rare, with only about 10 cases reported globally, all localized to the cheek, and none with associated bridging scar formation.

We report the first case of an eyebrow pilonidal sinus with a 29-year disease course accompanied by ipsilateral bridging scar formation. A 56-year-old man presented with right eyebrow swelling and intermittent drainage for 29 years following accidental trauma during high school. Physical examination revealed subcutaneous induration and epidermal depigmentation of the forehead and glabella, along with a bridging scar between the right eyebrow and nasal root. The patient complained of a sensation of temporal visual field obstruction due to mechanical traction. Surgical excision with adjacent flap transfer was performed initially, followed by forehead tissue expander placement and Z-plasty revision for recurrent scarring. Three sessions of postoperative intralesional injections (triamcinolone acetonide + fluorouracil) were administered as a prophylactic measure. Pathology confirmed chronic post-traumatic pilonidal sinus with foreign body giant cell reaction. At 1-year follow-up, the scar, visual field, and appearance were significantly improved with no recurrence.

This first reported case of eyebrow pilonidal sinus with bridging scar highlights the importance of considering this rare entity in the differential diagnosis of chronic facial lesions. Staged surgical reconstruction combined with adjuvant therapy can achieve satisfactory functional and aesthetic outcomes in this challenging anatomical area.