Interdigital Pilonidal Sinus

In the web space of his left hand, a 50-year-old barber had a painful cystlike lesion. The lesion had recurred intermittently, despite oral antibiotic treatment and warm compresses. The patient's father, also a barber, had a similar, more severe condition, which eventually required surgical intervention.

Scott J. M. Lim, DO, and Joe Nellis, DO, of Erie, Pa, noted cystic erythema with granulation tissue on the dorsal aspect of the left hand. Purulent material was expressed from the lesion. An orifice with tiny shards of embedded hair inferior to the cystic lesion within the web space was also noted.

The differential diagnosis included a local abscess with a sinus tract secondary to a foreign body, bacterial infection, and parasitic infection. Because of the hair shards within the sinus tract, foreign-body reaction with possible secondary bacterial infection was the most likely diagnosis.

Interdigital pilonidal sinus of the hand (barber's interdigital sinus, barber's disease, hairdresser's syndrome) has been observed in barbers and hairdressers as well as in animal groomers. The exact pathophysiology is uncertain; however, the lack of hair follicles in the interdigital spaces of the hand suggests that a pilonidal cyst/sinus at this site results from the penetration of animal or customers' hair in the skin.¹ Histologic examination has demonstrated multiple hair shards within sinus tracts with and without abscesses, which were as big as 2.5 cm.^1-4

In most patients, definitive treatment of interdigital pilonidal sinus requires surgical excision of the sinus tract.^1-4 In a recent study, in which excision and rotational flap repair were used, the investigators found that conservative management was relatively ineffective and concluded that surgery was the preferred treatment.⁴

This patient's lesion was debrided. He was advised to continue his current antibiotic treatment and to protect his hands with gloves or another protective barrier, such as cyano-acrylate–type glue, liquid bandage, or adhesive bandage/tape. Gloves with the fingertips cut off and barrier creams are other options. The patient was referred to a hand surgeon for definitive treatment.

Inform patients who work as barbers, hairdressers, or animal groomers about this condition so that they are alert for interdigital irritation. Frequent hand washing-with particular attention to the web spaces-and use of appropriate protective barrier measures when irritation is first noted can prevent the formation of a sinus tract.

References:

REFERENCES:

1.

Adams CI, Petrie PW, Hooper G. Interdigital pilonidal sinus in the hand.

J Hand Surg [Br].

2001;26:53-55.

2.

Papa CA, Ramsey ML, Tyler WB. Interdigital pilonidal sinus in a dog groomer.

J Am Acad Dermatol.

2002;47(5 suppl):S281-S282.

3.

Patel MR, Bassini L, Nashad R, Anselmo MT. Barber's interdigital pilonidal sinus of the hand: a foreign body hair granuloma.

J Hand Surg [Am].

1990;15:652-655.

4.

Uysal AC, Alagoz MS, Unlu RE, Sensoz O. Hair dresser's syndrome: a case report of an interdigital pilonidal sinus and review of the literature.

Dermatol Surg.

2003;29:288-290.