A Pinpoint Orifice on the Glans Penis of a Young Man

A. Pilonidal sinus

Surgical incision revealed multiple protruding hairs. The lesion was excised and sent for histopathological analysis, which revealed a sinus tract in the dermis lined by stratified epithelium and filled with hair shafts, surrounded by a lymphoplasmacytic inflammatory infiltrate (Figure, D). The wound healed by secondary intention, and the patient had a successful recovery with no signs of recurrence at 6-month follow-up.

A pilonidal sinus is a benign tract that contains hair fragments and extends from a skin-lined opening into the subcutaneous tissue. It is a chronic inflammatory condition most frequently located in the natal or gluteal cleft; this is why the condition was initially thought to be congenital. However, there is now consensus that pilonidal sinus is an acquired lesion.¹ Some authors propose that local trauma and friction produce subcutaneous trapping of hair, leading to the formation of a cyst and then a sinus to drain the suppuration.^1,2 However, more current reports suggest that these lesions may be localized forms of hidradenitis suppurativa.^3- 5 Pilonidal sinuses in unusual locations have been reported, including the scalp, neck, abdomen, groin, axilla, and even amputation stumps; these locations correlate with the classic sites of hidradenitis suppurativa. However, penile involvement is considered rare.^6,7 The few reported cases all occur in uncircumcised men, suggesting that the prepuce plays a role in the mechanical forces needed for the implantation of hair; other factors, such as shaving, high body mass index, and hirsutism, have also been proposed as contributory. Clinical presentation varies and includes penile papules and swelling; in complicated cases, there may be abscess formation, coinfection, and even ulceration mimicking sexually transmitted infections and penile carcinoma.⁸ Additional findings that may point to the diagnosis are hair protruding from the cavity and a central orifice on dermoscopy.⁹ Treatment is surgical with excision of the tract and healing by secondary intention.