Pilonidal Cyst

  • Medical Author:
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

  • Medical Editor: Jerry R. Balentine, DO, FACEP
    Jerry R. Balentine, DO, FACEP

    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Pilonidal cyst facts

  • Pilonidal cysts are sacs filled with hair and skin debris that form at the top of the crease of the buttocks above the sacrum. A painful abscess can form if the cyst and the overlying skin become infected.
  • Pilonidal cysts are caused by groups of hairs and debris trapped in the pores of the skin in the upper cleft of the buttock, forming an abscess.
  • Risk factors for pilonidal cysts include being male, sedentary, having thick body hair, family history, being overweight, and previous pilonidal cysts.
  • Symptoms of pilonidal cysts include
    • pain,
    • redness,
    • swelling,
    • fever, and
    • if the abscess ruptures, there may be discharge of blood or pus.
  • Treatment for pilonidal cysts involves incision and drainage (I&D) or surgery.
  • Home remedies include sitz baths and some vitamin supplements.
  • The prognosis for a pilonidal cyst is generally good. Recurrences are common.

What is a pilonidal cyst?

A pilonidal cyst is a sac filled with debris and hair that occurs in the area at the top of the crease of the buttocks overlying the tailbone (sacrum). This cyst and the overlying skin in the area can become infected, forming a painful abscess.

Picture of a pilonidal cyst
Picture of a pilonidal cyst

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Pilonidal Cysts: What Are the Risk Factors?

Most experts believe that the cysts arise due to trauma to the area that results in ingrown hairs. Pilonidal cysts often contain hair when excised, but hair follicles have not been demonstrated in them, suggesting that the hair may have been introduced from outside the cyst. Pilonidal disease was a common problem among servicemen during World War II, thought to be due to the mechanical trauma of riding in jeeps, trucks, and tanks.

What causes a pilonidal cyst?

It is not clear why pilonidal cysts form. At one time, it was thought pilonidal cysts might be congenital (a person is born with them) arising from embryologic cells that were in the wrong place early in development or due to repeat trauma (jeep driver's disease). It is now thought that small groups of hairs and debris (dead skin cells and bacteria) get trapped in the pores of the skin in the upper cleft of the buttock and form a "sinus," or pocket, that grows to become an abscess. This abscess forms under the skin (subcutaneously) and can result in scar tissue that can become infected repeatedly.

Some babies are born with an indentation just above the crease of the buttocks called a sacral dimple. If the sacral dimple becomes infected, it can become a pilonidal cyst.

What are risk factors for a pilonidal cyst?

Risk factors for pilonidal cysts include the following:

  • Male predominance (four times more often than in women)
  • Young age (most commonly found in men in their 20s)
  • Sedentary lifestyle
  • Thick body hair
  • Family history
  • Local shaving or damage to the skin from friction
  • Overweight or obese
  • Previous pilonidal cyst

What are pilonidal cyst symptoms and signs?

If a pilonidal cyst is not infected, there may be no symptoms. When a cyst is infected, signs and symptoms include

  • fever,
  • pain to the top of the buttocks,
  • low back pain,
  • swelling,
  • redness,
  • discharge of blood or pus (if abscess ruptures or "pops"), and
  • foul-smelling odor.

How do doctors diagnose a pilonidal cyst?

A doctor will diagnose a pilonidal cyst by first doing a physical examination. A pilonidal cyst looks like a lump, swelling, or abscess at the cleft of the buttock with tenderness, and possibly a draining or bleeding area (sinus). The location of the cyst at the top of the buttocks makes it characteristic for a pilonidal cyst.

If infection is severe, blood tests may be performed for diagnosis. There is usually no need for imaging tests in cases of pilonidal cysts.

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Are there any home remedies for a pilonidal cyst?

Home remedies are aimed at relieving pain and swelling. These home treatments include the following:

  • Sitz baths: Sitting in a tub of warm water up to the hips can relieve pain and may reduce the chances the cyst will worsen.
  • Vitamin C and zinc supplements can help in the healing process. Vitamin A also helps with tissue repair. Consult a doctor for the right dose of these supplements.
  • Essential oils, such as tea tree oil and sage oil, may help soothe the cyst and may even help fight infection.
  • A product called No Bump Rx helps prevent ingrown hairs.
  • Castor oil applied to the cyst may help reduce inflammation.
  • A coccyx cushion or pillow can provide support and comfort while sitting.
  • Regular exercise helps improve blood flow, which can aid in healing.

It has been suggested that raw garlic applied directly to the cyst may help with infection, however, it can be extremely irritating to the skin and the open wound. Talk to your doctor before using any herbal supplement or natural remedy as some may interact with medications you are on. In addition, if your cyst has been drained and is open, you need to follow your doctor's instructions.

What is the treatment for a pilonidal cyst? Is surgery necessary for pilonidal cysts?

Treatment for pilonidal cysts involves draining the infection (abscess), usually by lancing open the wound. A procedure called an "incision and drainage" (I&D) is performed either using local anesthesia or general anesthesia; an I&D drains pus and debris from inside the cyst cavity. Pit picking is a non-excision procedure that involves a lateral (side to side) incision that drains the cyst, and the midline pits leading under the skin are removed.

If extensive scar tissue or chronic sinus tract is found in the pilonidal cyst area, a more extensive excision surgery may be needed for removal of the abscess. A pilonidal cystectomy removes the cysts or tracts that extend from the sinus. The wound may be left open with gauze packing or sutured shut. A cleft lift/modified Karydakis procedure only removes scarred skin, and not deeper tissue, and the incision is more to the side for improved healing. Other types of surgeries for pilonidal cyst include flap procedures such as the Limberg flap, Z-plasty, and rotational flap, which remove larger amounts of tissue. They are usually not a first line of surgical treatment.

If there is a severe infection (cellulitis or sepsis), or if a patient is immune-suppressed (patients with HIV/AIDS, cancer chemotherapy, on steroid treatment, or other immune-modulating medications), antibiotics are usually prescribed and hospitalization may be necessary.

Recovery time for pilonidal cyst surgery varies depending on whether you are left with an open or closed wound. If you have an open wound (tissue is removed, leaving a cavity, and the body heals from the inside out) it can take eight weeks for it to heal into a patch of scar tissue. If you have a closed wound (sutured by the doctor), healing is much faster, however, there is a greater chance for reinfection which can delay healing. Recovery time for the cleft lift/modified Karydakis procedure is about four weeks. In general, inflammation will last up to six days, and growth of new tissue continues for about two months.

The only time nonsurgical treatment for a pilonidal cyst is considered is if the cyst is minor and symptoms are mild and infrequent. Prevent the cyst from getting worse by using good hygiene, exfoliating the area, sitting with good posture, and using a coccyx cushion.

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What types of doctors treat pilonidal cysts?

A primary care provider (PCP), such as a family practitioner, internist, or pediatrician, may diagnose a pilonidal cyst. A dermatologist may also be seen because many patients believe it's a skin-related problem. You may also see an emergency medicine specialist in a hospital emergency department.

If the cyst needs to be drained, a primary care physician, emergency medicine physician, a general surgeon, or colorectal surgeon may perform the procedure.

What is the prognosis of a pilonidal cyst?

The prognosis for a pilonidal cyst is generally good, and often the cyst can be cured with surgery. Unfortunately, reoccurrence of abscesses is frequent if extensive scar tissue or sinus formation occurs. Surgical treatment can be curative although, even with surgery, a small amount of cysts may reoccur. Complications include infection or scarring to the area.

Is it possible to prevent a pilonidal cyst?

In people prone to, or with risk factors for pilonidal cysts, modifying risk factors may help prevent flare-ups. Prevention of pilonidal cysts involves proper hygiene. Keeping the area clean and hair-free and exfoliating are the first steps. Losing weight and avoiding clothing that chafes the coccyx area helps prevent inflammation or infection. Prevention also entails proper sitting posture that can aggravate the tailbone area, and use of a coccyx cushion to keep pressure off the tailbone (a hemorrhoid "donut" pillow is not adequate for pilonidal cyst patients).

REFERENCES:

Sullivan, Daniel J., David C. Brooks, and Elizabeth Breen. "Intergluteal pilonidal disease: Clinical manifestations and diagnosis." UpToDate.com. Jan. 2015. <http://www.uptodate.com/contents/intergluteal-pilonidal-disease-clinical-manifestations-and-diagnosis?source=search_result&search=pilonidal+cyst+cause&selectedTitle=1~17>.

Sullivan, Daniel J., David C. Brooks, and Elizabeth Breen. "Management of intergluteal pilonidal disease." UpToDate.com. Jan. 2015. <http://www.uptodate.com/contents/management-of-intergluteal-pilonidal-disease?source=search_result&search=pilonidal+cyst+cause&selectedTitle=6~17>.

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Reviewed on 8/2/2017
References
REFERENCES:

Sullivan, Daniel J., David C. Brooks, and Elizabeth Breen. "Intergluteal pilonidal disease: Clinical manifestations and diagnosis." UpToDate.com. Jan. 2015. <http://www.uptodate.com/contents/intergluteal-pilonidal-disease-clinical-manifestations-and-diagnosis?source=search_result&search=pilonidal+cyst+cause&selectedTitle=1~17>.

Sullivan, Daniel J., David C. Brooks, and Elizabeth Breen. "Management of intergluteal pilonidal disease." UpToDate.com. Jan. 2015. <http://www.uptodate.com/contents/management-of-intergluteal-pilonidal-disease?source=search_result&search=pilonidal+cyst+cause&selectedTitle=6~17>.

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