A true pilonidal sinus in the hand of a sheep shearer

Abstract

Occupationally acquired inter-digital pilonidal sinuses are seldom seen and typically found on the hands of hair dressers. Sheep shearing has traditionally been believed to be a cause of inter-digital pilonidal sinuses; although in reality it is infrequently so with only two previously reported cases in 1951 and 1966.We present a rare case of a shearer who worked with a variety of sheep and presented with a chronic pilonidal sinus in the 3rd web space of his hand. This work demonstrates for the first time a histological confirmation of the presence of wool, and in this case different varieties and coloured fibres within the sinus.The report presents our investigations into the aetiology and the mechanical theories supporting it. The clinical presentation and surgical management of this condition are discussed alongside occupational realities and expectations.

The presence of occipital hair in the pilonidal sinus cavity—a triple approach to proof

“…From barbers [27], sheep shearers [28], and dog shearers [20], we have learnt that occupational exposure to large quantities of cut hair fragments leads to increased hair injection at the rostral side of their bodies. Not a single report has been indicating a higher pilonidal incidence at the back side of these people.…”

Barber's Syndrome

“…The patient applied to various centers for 1.5 years and had long-term antibiotic treatment. Isolated antibiotic therapy is not curative for the plenoidal sinus [1][2][3][4][5][6][7][8][9][10]. Antibiotics are used in the presence of active pre-surgical infection, for the eradication of infection, or prophylactically in the postoperative term [8,9].…”

“…Literature review shows that less than 15 of the more than 50 cases of plenoidal sinus are barber's Syndrome [1]. Other than that, it can be seen in pet groomers and goat milk milkers [4][5][6][7][8].…”

“…Treatment is secondary recovery after surgical excision, or primary suturation, or repair with rotation flap. Antibiotic therapy alone is not enough [1][2][3][4][5][6][7][8][9][10][11][12].…”

Pilonidal sinus in palmar webspace of a male barber: a case report with review of literature

“…7 Males are more prone to develop this condition than female hairdressers. Owing to their proper cleansing techniques and habits, of the interdigital spaces, female show lesser incidence than males.…”