JOCS
Journal of Comprehensive Surgery

The aim of the Comprehensive Surgery is to publish original research articles of the highest scientific and clinical value at the international level in all surgical fields.

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The gut microbiota–follicular axis in pilonidal sinus disease: lessons from hidradenitis suppurativa and surgical implications
Abstract
Pilonidal sinus disease (PSD) and hidradenitis suppurativa (HS) are both members of the follicular occlusion tetrad — a group of chronic inflammatory disorders sharing a common pathogenetic basis of follicular occlusion, subcutaneous tract formation, and recurrent abscess development. While PSD has traditionally been approached as a purely mechanical and anatomical problem, emerging evidence from the HS literature reveals a compelling gut microbiota–skin axis that may be equally operative in PSD. In HS, intestinal dysbiosis, increased intestinal permeability, and elevated systemic lipopolysaccharide levels have been documented through multiple study designs including Mendelian randomization analyses, providing causal evidence that gut microbial imbalance drives systemic immune dysregulation and amplifies local follicular inflammation. Both diseases harbor dysbiotic, anaerobic-predominant, biofilm-forming local microbiota — particularly Prevotella and Finegoldia species — capable of perpetuating chronic inflammation and resisting surgical eradication. This narrative review synthesizes current evidence on the gut microbiota–follicular axis in HS and PSD, examines the shared immunological and microbial mechanisms underlying both conditions, and proposes that the gut-skin axis insights established in HS are pathobiologically transferable to PSD. Importantly, PSD carries an understudied but emerging association with inflammatory bowel disease, mirroring the established HS–IBD comorbidity and further supporting a shared gut-driven inflammatory pathway. Microbiome-targeted adjunctive strategies — including perioperative probiotic supplementation, biofilm-disrupting local therapies, and dietary modulation — represent rational, evidence-informed approaches to reducing recurrence and postoperative complications in PSD surgery. We propose a structured research agenda for microbiome-integrated prospective PSD cohort studies and call for the first randomized trials of gut-targeted interventions in PSD surgical management.

Keywords : Pilonidal sinus disease, hidradenitis suppurativa, gut microbiota

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Author Contributions

Concept: DK; Design: DK; Control: GD; Data Collection and/or Processing: GD; Analysis and/or Interpretation: DK; Literature Review: DK, GD; Writing the Article: DK, GD; Critical Review: DK, GD.

Conflict of Interest

The authors declare no conflicts of interest related to this study.

Financial Disclosure

The authors received no financial support for the conduct or publication of this research.

Editor Note

Gürkan Değirmencioğlu is a member of the Editorial Board of this journal. He was not involved in the editor assignment, reviewer selection, peer review process, or editorial decision for this manuscript. The peer review process was managed independently by another editor.


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Article available in :
Volume 4, Issue 4, 2026
Page : 106-111
https://doi.org/10.51271/JOCS-0086
Article Information
Received : 14 Haz 2026
Accepted : 18 Tem 2026
Published : 28 Eki 2026
Corresponding Author :

Deniz Kütük: Department of General Surgery, Ankara Etlik City Hospital, Ankara, Turkiye

[email protected]
Citation : Kütük D, Değirmencioğlu G. The gut microbiota-follicular axis in pilonidal sinus disease: lessons from hidradenitis suppurativa and surgical implications. J Compr Surg. 2026;4(4):106-111. doi:10.51271/JOCS-0086

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