The Origin of Pilonidal Sinus Disease – 10 wrong Theories and one Recent Discovery

Introduction: In the last two centuries, many theories have been proposed to explain the origin of pilonidal sinus disease (PSD) – congenital and acquired. Materials and Methods: A PubMed literature review was conducted and looked at different proposed theories on the origin of PSD; this overview was then compared to research results from more recent studies. Results: Initially it was postulated, that PSD was of embryonic origin. This however changed during World War II as more 78.000 American soldiers were diagnosed and treated for PSD. Thereafter, the perception of the origin of PSD changed to an acquired one. New data has shown that short hair fragments, which have fallen from the scalp may be the origin of PSD – therefore disproving the theory of folliculitis and fatty gland obstruction. Conclusion: These new findings may explain why recurrences/new diseases occur within follicle-free areas – such as scars and without any preceding infection. This may aid in the prevention of PSD.