When you run your hands over the soles of your feet, the surface should be smooth to touch. However, sometimes, the surface may not be so smooth. Piezogenic pedal papules are papules on the medial, posterior or lateral aspects of both heels and result from herniation of fat. These papules are usually asymptomatic and can range from a size of 2mm to 10mm. In some cases, they can be a little painful. This is seen commonly in large lesions. They become apparent when the patient stands with his full weight on his feet and disappear or shrink when the weight is removed. Piezogenic papules can also occur on the wrists. This is a fairly common condition that affects women more than men. Piezogenic pedal papules can occur at any age including infancy.

There is no known cause for the herniation of fat that causes this condition. However, there are a few factors that could increase your risk of suffering from this condition. These factors are:

Obesity
Orthopedic problems
Flat feet
Collagen disorders such as EDS
Jobs which entail standing for long hours
Excessive weight bearing
This condition can also affect newborn babies with no predisposition. The diagnosis of this condition is often confused with infantile pedal papules, xanthoma and tophi. Since they are prominently visible only when pressure is applied, it is essential for a doctor to physically examine the patient while he or she is standing. This condition does not affect the health of a person and is largely only a cosmetic issue. Thus treatment is not usually necessary but some of the things you could do to relieve the discomfort are:

In cases where Ehlers-Danlos syndrome triggers the condition, patients may be recommended betamethasone and bupivacaine injections. These injections need to be administered repeatedly for complete pain relief.
Orthotic soles or custom made inserts for shoes can help relieve the pain and distribute pressure equally.
Heel taping
Compression stockings
Avoid excessive or prolonged weight bearing
Avoid standing for extended periods and try not to run too much
Rest the feet and keep them elevated to help alleviate the symptoms
Lose weight if you are on the heavier side
Electro acupuncture
Piezogenic pedal papules are benign and are no reason to worry. If they begin to affect the quality of your life, you could consult a podiatrist. 

What are Piezogenic Pedal Papules?

Pilonidal Sinus is the small channel in your skin near the tailbone that may sometimes be filled with pus or fluid. This accumulated pus leads to the formation of abscess or cyst. Pilonidal cysts occur near the coccyx or tailbone, right at the top of the buttock crease. Pilonidal sinus consists of dirt, hair and debris that penetrates your skin, becomes embedded and thereby causes infection. Once the cyst gets infected, you may see blood or pus oozing out of the channel, which causes severe pain.
Pilonidal sinus usually affects men and young adults (after puberty). This type of skin disease is mostly observed in people who sit for a prolonged period, such as desk-job workers, truck drivers etc.

What are the causes and symptoms? 
Doctors suggest pilonidal sinus or cysts is caused due to factors such as - hormonal changes during puberty, friction resulting from wearing tight clothes, prolonged sitting, hair growth etc. The hair growing in the region is forced to burrow back beneath your skin. In certain cases, the patient may develop multiple sinuses which connect under the skin.

The signs and symptoms of pilonidal sinus include-

  Pain when standing or sitting for long
  Swelling of the cyst
  Redness and soreness around the affected skin
  Formation of multiple holes (sinus tracts) in the skin
  Foul odor
  Blood or pus oozing out of the abscess
  Hair sticking out of the lesion
Pilonidal sinus can be embarrassing and painful if left untreated for long.

What is the treatment for this condition?
Pilonidal sinus usually goes away on its own, without medical intervention. However, if the cyst becomes infected, it may have to be operated or drained. The commonly used treatment procedures are-

  Conservative treatment - if the condition is diagnosed at an early stage, your doctor will prescribe a broad-spectrum antibiotic to treat a broad range of bacterial infection. This will relieve you from the pain and discomfort resulting from infection.

  Lancing - this procedure involves using a scalpel to open the abscess. Your doctor will give you an anaesthetic prior to the operation. The channel is then cleaned properly to drain out blood, pus or hair. The wound is packed with a sterile dressing and left to heal. It usually takes about a month for the wound to heal, after which no further treatment is required.

  Phenol injections - for this procedure, first and foremost, your doctor will give you anaesthetic so that you don t feel any pain. A chemical compound known as Phenol is injected into the cyst. Phenol acts as an antiseptic and is used to harden and eventually close the lesion. This procedure needs to be repeated multiple times to achieve the desired result.

  Surgery - if the pilonidal sinus tends to recur, or if you develop multiple sinus tracts, the most preferred choice of treatment is surgery. The surgeon will open the lesion, remove the debris and pus, and then suture the wound. You will be given an anaesthetic prior to the surgery, and once the treatment is done, you will need to change the dressing more often.
If you suffer from pilonidal sinus, you will also need to maintain good hygiene. Make sure you clean and wash the area with a mild soap, and rinse properly. If your job requires you to sit for a prolonged period, take a break in between your work. Avoid wearing skin tight clothes. Adopting these measures will help prevent the occurrence of pilonidal sinus.

Treatment For Pilonidal Sinus!

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