na vel. Spo radic in cidences of im plan ta tion of pilonidal si nus have been reported. The dis ease is mostly ob served in hair dressers, but it has also been re ported spo rad i cally in other professions, as male sheep shearer, dog groomer, slaughter men or milker of cows. Short cus tom ers' hairs that pen e trate the sup ple interdigital skin of the hands pro duce bar ber's dis ease. Though there are only a few re ports about these pe cu liar si nuses in the avail able lit er a ture, they should be sus pected in any chron i cally dis charg ing, non-heal ing si nus or wound. A clin i cal suspicion of ma lig nant trans for ma tion or af fec tion with tu ber cu lo sis in the en demic area should also be kept in mind to avoid any de lay in the treat ment and the out come of the dis ease.

Hemorrhoids are a very common anorectal disorder defined as the symptomatic enlargement and abnormally downward displacement of anal cushions. Hemorrhoids become pathognomonic due the degenerative change of supportive tissue within the anal cushions, vascular hyperplasia, and hyperperfusion of hemorrhoidal plexus. Early grades of hemorrhoids (Grade I and 2) can be effectively treated with dietary and lifestyle modification, pharmacological treatment, and different office-based procedures. Surgical intervention is indicated in symptomatic and advanced grades of hemorrhoids. Although hemorrhoidectomy is still considered as the gold standard, more recently, newer approaches like Ligasure and ultrasonic hemorrhoidectomy, stapled hemorrhoidopexy, and doppler-guided hemorrhoidal artery ligation have been used with a desirable success. However, post-procedural pain and disease recurrence remain the most challenging problems. This article deals with the pathophysiology and evidence based approach to hemorrhoidal diseases.