The Origin of Pilonidal Sinus Disease – 10 wrong Theories and one Recent Discovery
AJTES Vol 7, No 2, July 2023
Dettmer M et al. The Origin of Pilonidal Sinus Disease – 10 Wrong Theories and one Recent Discovery.


Pilonidal sinus disease
short hair fragments

How to Cite

Dettmer, M., Degiannis, K., Braun-Münker, M., Doll, D., & Maak, M. (2023). The Origin of Pilonidal Sinus Disease – 10 wrong Theories and one Recent Discovery. Albanian Journal of Trauma and Emergency Surgery, 7(2), 1296-1299.


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.
Dettmer M et al. The Origin of Pilonidal Sinus Disease – 10 Wrong Theories and one Recent Discovery.


Anderson, A.W., Hair extracted from an ulcer. Boston Med Surg J, 1847. 36: p. 74.

Luschka, H., Die Steissdrüse des Menschen. Arch Pathol Anat, 1860. 18: p. 106-15.

Feré, C., Cloisonnment de la cavite pelvienne; Uterus et vagin double; infudibulum cutane de la region sacro-coccygienne. Bull. Soc. anat. de Par., 1878. 53.

Lannelongue, O. and C. Achard, Traité des kystes congénitaux. 1886, Paris.

Madelung, Centralbl. f. Chirurg., 1885. 44.

Tourneux, F. and G. Herrmann, Sur la persistance de vestiges medullaires coccygiens pendant toute la periode foetal chez l`homme et sur la role de ces vestiges dans la production des tumeurs sacro-coccygiennes congenitales. J Anat Physiol (Paris), 1887. 23: p. 498.

Casberg, M.A., Infected pilonidal cysts and sinuses. Bull US Army Med Dep, 1949. 9(6): p. 493-6.

Buie, L.A. and R.K. Curtiss, Pilonidal disease. Surg Clin North Am, 1952: p. 1247-59.

Buie, I., Jeep disease (pilonidal disease of mechanized warfare). South Med J, 1944. 37: p. 103-109.

Patey, D. and R.W. Scarff, PATHOLOGY OF POSTANAL PILONIDAL SINUS ITS BEARING ON TREATMENT. The Lancet, 1946. 248(6423): p. 484-486.

Hueston, J.T., The aetiology of pilonidal sinuses. Br J Surg, 1953. 41(167): p. 307-11.

Palmer, W.H., Pilonidal disease: a new concept of pathogenesis. DCR, 1959. 2(3): p. 303-7.

Ahmad, H.M., M. Jalilallah, and M. Al-Rashedy, Pilonidal Sinus And Prolonged Sexual Stimulation: The Poisonous Hormones. The Internet Journal of Surgery, 2005. 8(1): p.

Favre, R. and P. Delacroix, Apropos of 1.110 Cases of Pilonidal Disease of Coccy-Perineal Localization. Mem Acad Chir (Paris), 1964. 90: p. 669-76.

Akinci, O.F., et al., Natal cleft deeper in patients with pilonidal sinus: implications for choice of surgical procedure. Diseases of the Colon and Rectum, 2009. 52(5): p. 1000-2.

Doll, D., V.K. Stauffer, and M.M. Luedi, Intra‐anal pilonidal sinus disease: a unique diagnosis possibly pointing to the occiput. ANZ journal of surgery 86 (7-8), 2016. 622.

Brengelmann, I.E., Die Rolle der präsakralen Schweißneigung in der Entstehung des Pilonidalsinus, in Universitätsklinikum des Saarlandes, Homburg/ Saar. 2020, Universität des Saarlandes. p. 92.

Doll, D., et al., Rethinking the causes of pilonidal sinus disease: a matched cohort study. Sci Rep, 2021. 11(1): p. 1-7.

Ozkan, Z., et al., Investigation of the relationship between serum hormones and pilonidal sinus disease: a cross-sectional study. Colorectal Dis, 2013. 16(4): p. 311-4.

Bosche, F., et al., The Hair in the Sinus: Sharp-Ended Rootless Head Hair Fragments can be Found in Large Amounts in Pilonidal Sinus Nests. World J Surg, 2018. 42(2): p. 567-573.

Doll, D., The hair of pilonidal sinus patients is significantly stronger when tested in vertical (Trajectory) force testings. European Surgical Research, 2017. 58: p. 66-67.

Doll, D., et al., The presence of occipital hair in the pilonidal sinus cavity-a triple approach to proof. IJCD, 2018. 33(5): p. 567-576.

Doll, D., et al., Immediate cut hair translocation to the intergluteal fold in the hairdressers shop – another link to pilonidal sinus disease. PSJ, 2019. 5(1): p. 23-32.

Gosselink, M. and G. Ctercteko The role of hair in the pathogenesis of pilonidal disease. ESCP Teachings - Pilonidal Sinus, 2017. 12.

Gosselink, M.P., et al., Scanning electron microscope imaging of pilonidal disease. Tech Coloproctol, 2017. 21(11): p. 905-906.

Petersen, S., et al., Long-term effects of postoperative razor epilation in pilonidal sinus disease. Dis Colon Rectum, 2009. 52(1): p. 131-4.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.