biolitec® in Coloproctology

Minimally invasive laser therapy of pilonidal cysts


In Focus

Coccyx fistulas: Dermatologist Dr. Kasten on the development, diagnosis and SiLaC laser therapy

News DrkastenRobert Kasten, MD, is a dermatology specialist and has been running his dermatology practice in Mainz since 2006. As an experienced dermatologist, he specializes in a wide variety of procedures in this field. For many years, his wide range of treatments has included biolitec's SiLaC laser therapy, which is used to treat coccyx fistulas.


  1. Kasten, what exactly is a coccyx fistula and how does it develop?

Coccyx fistula is a chronic inflammation in the fold of the buttocks. It is caused by ingrown hairs that lead to a foreign body reaction. Cavities form under the skin, from which unpleasant smelling secretion escapes.

The term coccygeal fistula is technically incorrect, since the inflammation is mainly located above the sacrum and not above the coccyx. In addition, the fistula ducts do not have a connection to the bone. A more appropriate term would be "pilonidal sinus". These terms take into account that ingrown hairs (Latin: pilus for hair and nidus for nest) are responsible for the condition.


  1. Are there certain risk factors that favor this disease?

The disease mainly affects younger men who have more hair and sweat more. Prolonged sitting can also favor the occurrence of a pilonidal sinus.


  1. What symptoms do I notice as a patient that I might have a coccyx fistula?

Often our patients notice oozing in the gluteal fold, which is manifested, for example, by stains in the underwear. Some also notice an unpleasant odor. It is not uncommon for painful inflammation with swelling and suppuration to occur in the gluteal fold.


  1. How do you diagnose coccyx fistula? Are there any specific procedures for this?

Most of the time, you can diagnose a coccyx fistula clinically. Using a special magnifying glass called a dermatoscope, you can see what are called "pits." The pits are the openings of the fistula ducts towards the surface. Sometimes "wild flesh" forms around the pits, i.e., a reddish oozing, raised granulation (newly formed tissue that develops during the wound healing process). In special cases, an ultrasound examination or an MRI scan may be required. These examinations are painless. As part of the treatment, the extent of the fistula tract is examined with a probe. This is done under local anesthesia.


  1. Does a coccyx fistula always have to be treated or can it heal on its own?

A coccyx fistula almost never heals on its own because the ducts and the cavities are lined with so-called epithelial tissue, which prevents closure, and there is also hair under the skin. In order for a pilonidal sinus to heal, the hair and epithelium must be removed. In addition, the hair must be permanently removed with laser or IPL to reduce the risk of recurrence.  If inflamed pilonidal sinus persists for many years, squamous cell carcinoma may even develop on rare occations.


  1. What treatment options do I have as a patient?

Unfortunately, self-treatment of the pilonidal sinus is not possible. However, a specialized physician can usually help and provide relief from this distressing condition. Meanwhile, less invasive therapies are available that allow a quick return to everyday life.  These include pit-picking, in which the fistula openings are removed, and sclerotherapy of the epithelium of the fistula ducts and cavities with a laser.


  1. How does SiLaC laser therapy work and what special features does it offer?

During the laser treatment, the fistula ducts are sclerosed so that the ducts and cavities can close. Beforehand, we clean the duct systems of hair and inflamed tissue. Healthy skin and the unaffected subcutaneous tissue are spared, so that one can very quickly participate in everyday life again. This method can be repeated several times if necessary.  In addition, permanent hair removal with laser or IPL should definitely be performed, so that hair does not grow again in the buttock crease.


  1. How long does the treatment last and when will I be fit again?

The treatment generally lasts between 30 to 45 minutes and is performed under local anesthesia. When one can participate in everyday life again depends, of course, on the severity of the condition and the extent of the therapy. Most patients can shower again the day after the operation. Swimming pools, sports and saunas should be avoided for about 2 weeks.  It can take several weeks for the wounds to heal completely. If after 6 weeks there is still oozing in the buttock crease, further laser therapy may be necessary.