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Suggest Treatment For Recurring Cleft Tear Of Skin

Posted on Mon, 2 Mar 2015

Question: Hi For the past 12 months I have a recurring natal cleft tear of the skin. The tear begins nearest the anus and is about an 1/2 inch long. It occurs once per month for 3-5 days and heals. My GP thought it may be a Pilondal cyst, however I visited a Colon rectal surgeon and he could not find a cyst. At the time of my visit, there was no split in the skin. I do not have any blood or pain during a bowel movement. I was treating it as a possible fungal infection using cream mixed with hydrocortisone. Hope you can help based on the attached picture.

Answered by Dr. Deepak Kishore Kaltari (52 minutes later)

Brief Answer:
Possibly Pilonidal Sinus

Detailed Answer:
Hi
Welcome to Healthcaremagic
Greetings of the day
Dear Sir

Thanks for providing the clinical photograph, it really helps. Based on clinical picture possibility of Pilonidal Sinus /CCyst needs to be considered. As you have repeated breaking down of the skin , the diagnosis is very much likely. Other cause of this could be due to maceration (softening of skin ) associated with excessive sweating. As the cleft is least exposed to air , the secretion and sweat do not adequately dry up, this leads to softening of skin and breakdown of skin. Exact diagnosis will depend on clinical examination.

I would suggest you the following

1. Keep the area clean and dry.

2. Bath twice a day

3. Hot Seitz bath : To a tub of lukewarm water add 2 spoons of antiseptic solution. Sit in it for 15 to 20 minutes each session twice a day before taking bath .

After bath thoroughly dry off the area by dabbing (do not rub the towel vigorously ).

4. Keep the area shaved and clean

5. Application of antifungal dusting powder after drying the area and just before retiring to bed will help maintain dryness

6. Use cotton inner wear

Do get back to me if you need any further assistance, will be glad to assist you.

Take care

Best regards
Dr Deepak Kaltari
Consultant Surgeon

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Deepak Kishore Kaltari (37 hours later)

Thanks for the quick response. In the event this is a sinus/cyst, I am looking to manage this versus the surgical option. Duration is 5 days, no discharge, no blood, just uncomfortable. After review of the surgical option it appears the success rate is low, (return of cyst is high) , risk of infection and recovering time. Is there any steps I could take to lower the frequency of the break out/ tear to the natal cleft through changes in diet and or weight loss etc?

I currently use hydrocortisone mixed with an anti bacterial cream during the 5 days of the natal cleft tear.

My colon rectal surgeon could not confirm the presence of a cyst, he advised a ultrasound be performed. Is this a definitive way to confirm the presence of a cyst, or abnormal sinus in the natal cleft?

Thanks

Answered by Dr. Deepak Kishore Kaltari (1 hour later)

Brief Answer:
Thorough clinical examination very important to establish diagnosis

Detailed Answer:
Dear Sir,

Thorough clinical examination is the best way to establish diagnosis of Pilonidal Sinus and Cyst. Following the previous advise will definitely help prevent recurrence. If it still recurs then Surgery needs to be considered. Well done Surgery there is less chance of recurrence. Taking precautions will help prevent recurrence.

Take Care

Regards
Dr Deepak

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar