Pilonidal Cyst

A pilonidal cyst is formed at the bottom of coccyx (the tailbone) near the cleft of buttocks. It appears like a large pimple. It contains skin debris, hair and abnormal tissue. Pilonidal cyst may get infected and filled with pus. This condition, known as pilonidal abscess, causes pain and inflammation. The term pilonidal is derived from the Latin words pilus, meaning hair and nidus, meaning nest. Pilonidal cyst occurs more frequently in men than in women. It is common in mid teens to early 20s.

Causes of Pilonidal Cyst

The exact cause of pilonidal cyst is not known. There are several different theories about the possible causes of pilonidal cyst. One theory suggests that pilonidal cyst is enlargement and rupture of a hair follicle due to normal stretching or motion of deep layers of skin. There is a formation of a cyst around the broken follicle. While some researchers believe that penetration of hair into the skin that results from friction and pressure due to rubbing of skin, sitting for long periods, tight clothing can give rise to pilonidal cyst. Responding to the hair as a foreign substance, our body develops a cyst around it.

Some children possess a sacral dimple (a small indentation in the skin) above the cleft of buttocks. Sometimes, this sacral dimple becomes infected, leading to a pilonidal abscess. People with obesity, excess body hair, stiff or coarse hair, poor hygiene and excess sweating are at a higher risk of developing a pilonidal cyst. An inactive lifestyle and occupation that requires a prolonged sitting are also responsible.

Symptoms of Pilonidal Cyst

There may not be any noticeable symptoms of pilonidal cyst. Its presence can be experienced as a small pit on the skin surface. When the pilonidal cyst is infected, it becomes a swollen mass or abscess. It can cause some symptoms such as pain over the lower spine, redness and warmth of the skin, localized swelling over the lower spine, drainage of pus from the pilonidal sinus, foul smell from draining pus, hair protruding from the pilonidal sinus and sometimes fever. A pilonidal sinus appears as a passage below the skin surface that connects the infected cyst to the opening on the skin surface. In chronic cases of infected pilonidal cyst, there is an increased risk of developing squamous cell carcinoma, a type of skin cancer.

Diagnosis and Treatment of Pilonidal Cyst and Abscess

Pilonidal cyst is diagnosed on the basis of symptoms and the findings in the physical examination. Pilonidal cyst doesn't require any treatment, until it is infected and becomes painful. An infected pilonidal abscess requires incision and drainage in order to heal. It is performed by a surgeon under local anesthesia. The surgeon opens the abscess and drains the fluid. Hair and other debris are removed from the abscess. This treatment is effective for about 50-60% cases of infected pilonidal cyst. In case of recurring infected pilonidal cyst, a surgical procedure is required. The cyst and sinus tract are opened to remove pus, hair and other debris.

There are two options for the surgical procedure such as open wound and closed wound. In open wound surgery, the surgical wound is left open and packed with dressing. It takes longer time for healing, but minimizes the risk of recurring pilonidal cyst infection. In case of closed wound surgery, the wound is closed with stitches after cleaning the cyst and sinus tracts. This takes a short period for healing, but there is a higher risk of recurrence.

In order to prevent further pilonidal cysts, you should regularly remove any hair from the area. You can opt for laser treatment for hair removal. Cleaning the area with glycerin soap causes less irritation. Always keep the area clean and dry and avoid sitting for a prolonged period.