Brief Answer:
Needs to be assessed clinically by a surgeon.

Detailed Answer:
Hi XXXX! Good morning. Nice to listen from you in the follow up.

Well, whenever you empty a cyst by squeezing, that leaves a sinus which might heal by itself with secondary intention or it might continue to discharge purulent material if the infection persisted in it.

As suggested by me earlier, with the present formation of a tract line specially of hard consistency as felt by you I would insist that you better get it clinically assessed by a general surgeon in your area, who after performing some basic routine tests like a complete blood count, blood sugar, gram staining and culture sensitivity test of the discharge from the sinus tract might advise you for undergoing an excision biopsy of the lesion for a definitive diagnosis, which could prove to be of therapeutic value as well.

I would like to listen from you on the diagnosis made by the surgeon at your place.

Thanks and good luck.

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Brief Answer:
The hardness of the sinus could be due to fibrosis.

Detailed Answer:
Hi XXXX ! Thanks for the fast response.

Yes, my first diagnosis still holds good as an infected sebaceous cyst in the penile skin which might have originated by the way of shaving. When the contents were squeezed, it would leave a tract (sinus) with some discharge which might heal or might persist. Because of the chronic nature of the your problem, the tract might have got fibrosed making it feel hard. This sequence would keep on getting repeated till the cyst was removed by the way of an excision biopsy and any tissue removed thus needed a pathological diagnosis by a pathologist to confirm our clinical diagnosis. With your history of the tract healing well, it does not seem to me to be of urgent need now. You could get it done in UK when you go back in two weeks. Both the ointments/creams mentioned by you are good enough, and you could use any.

Pilonidal sinuses are notorious in their recurrence rates even when the surgery might have been performed in best hands. The best time for re operation could be decided by your surgeon after a clinical examination. However,my suggestion would be to get it removed in the quiescent stage when there was no secondary infection in the tract. Post surgery, you would have to be careful while removing the hair in the area, a must for preventing the recurrence, and also avoid sitting for a long time on hard seat which might cause any hair to break and enter inadvertently into the skin causing the recurrence.

I hope I have answered your queries. However, in case of any more doubt, you are free to ask. All the best. Dr Shareef.

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