Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: Jay W. Marks, MD
Pilonidal cysts arise at the base of the tailbone (coccyx) of the lower back,
just above the natal cleft (the cleavage between the buttocks). Doctors
sometimes use the term pilonidal disease to refer to the range of problems that
can affect this area. In simple cases, a small, solitary cyst-like area
containing fluid is present without evidence of infection. In other cases, the
areas may become infected and filled with pus, creating a so-called pilonidal
abscess. When the condition is particularly severe, the infection can spread,
creating multiple abscesses and sinus tracts (abnormal paths of tissue
destruction). The term "cyst," which is generally used in this case, is actually a
misnomer since true cysts have a characteristic cellular lining that is lacking
in the vast majority of cases of pilonidal disease.
Small pilonidal cysts may not cause any symptoms if they do not become
infected. Symptoms and signs of a pilonidal cyst or abscess include swelling (a
localized "bump" may be noticed), pain, and redness at the base of the spine. In
the case of a pilonidal abscess, the pain and redness usually are greater, and
fever may be present.
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.
Pilonidal cysts occur along the tailbone near
the cleft of the buttocks.
Pilonidal cysts are thought to develop from the
penetration of hairs deep into the skin.
Pilonidal cysts can become infected.
An infected pilonidal cyst (pilonidal abscess) requires incision and drainage.
Recurrence of pilonidal cysts is common, and surgery may be required for more
definitive management.
What is a pilonidal cyst?
A pilonidal cyst is a fluid-filled sac (cyst) that develops along the tailbone (coccyx) near the cleft of the buttocks. These cysts usually contain hair and skin debris, and sinus tracts may develop. Some individuals with a pilonidal cyst or sinus may not have any symptoms at all, whereas others may develop an inflammation of the cyst that leads to abscess formation with associated pain, redness, and irritation. Despite treatment, recurrence of pilonidal cysts is common.
Pilonidal disease was first described by Herbert Mayo in 1833, with R.M. Hodge coining the term
pilonidal in 1880 from the Latin words
pilus (hair) and nidus (nest). Extensive work into the treatment and management of pilonidal disease occurred during World War II, when nearly 80,000 U.S. soldiers were treated in U.S. military hospitals for this condition between 1941-1945. Because so many of the affected servicemen rode in Jeeps for prolonged periods of time, the condition also became known as "Jeep disease."
What causes a pilonidal cyst?
Though there are several theories as to the cause of pilonidal disease, most researchers now believe that pilonidal disease is acquired (rather than congenital) and that it is caused by the penetration of hair into deeper subcutaneous tissues through dilated hair follicles in the skin. In response to this irritation and perceived foreign material, the body produces a local inflammatory reaction, causing a cyst to form around the trapped hair. Excessive pressure, friction, and repetitive trauma to the sacrococcygeal area are thought to facilitate the entry of hair, thus predisposing individuals to develop pilonidal disease or irritate already existing pilonidal cysts.
Who is at risk for developing a pilonidal cyst?
The incidence of pilonidal disease is approximately 26 cases per 100,000 people. Pilonidal disease generally occurs in people between the ages of 15-24, and it is very uncommon in individuals over the age of 40. Males are more frequently affected than females, and it is more common in white individuals. Other risk factors associated with the development of pilonidal disease include a family history of pilonidal cysts, occupations that require prolonged periods of sitting, local trauma, obesity, hirsute (hairy or having copious hair) individuals, and the presence of a deep cleft between the buttocks.
What are the signs and symptoms of a pilonidal cyst?
Certain individuals with a pilonidal cyst may not have any symptoms at all, and the only finding may be a dimple or an opening in the skin (sinus tract) near the cleft of the buttocks. However, if the pilonidal cyst becomes infected (pilonidal abscess), the following signs and symptoms may develop:
Pain over the lower spine
Redness of the skin
Warmth of the skin
Localized swelling over the lower spine
Drainage of pus from an opening in the skin (sinus tract) over the lower
spine
A boil is a skin abscess, a collection of
pus localized deep in the skin. There are several different types of boils. Among them are the following: furuncle or
carbuncle, Cystic acne, Hidradenitis suppurativa, and Pilonidal cyst.
Cellulitis is an acute spreading bacterial infection below the surface of the skin characterized by redness, warmth, inflammation, and pain. The most common cause of cellulitis is the bacteria Staph (Staphylococcus aureus).
Skin cancer is the most common form of cancer
in humans. There are three main types of skin cancer; basal cell carcinoma and
squamous cell carcinoma (the nonmelanoma skin cancers), and melanoma.
Cysts are saclike structures that can occur throughout the body and usually contain a semisolid, liquid, or gaseous substance. Infections, tumors, genetic conditions, chronic inflammatory conditions, and wear and tear can cause cysts. Though some cysts may be palpable, others may not produce any symptoms. Treatment depends upon the location and cause of the cyst.
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
Cellulitis is a spreading bacterial infection of the skin and tissues beneath the skin.
Staphylococcus and Streptococcus are the types of bacteria that are usually responsible for cellulitis, although many types of bacteria can cause the condition.
Sometimes cellulitis appears in areas where the skin has broken open, such as the skin near ulcers or surgical wounds.
Cellulitis is not contagious.
Cellulitis is treated with oral or intravenous antibiotics.
What is cellulitis?
Cellulitis is a bacterial infection of the skin and tissues beneath the skin. Unlike impetigo, which is a very superficial skin infection, cellulitis is an infection that also involves the skin's deeper layers: the dermis and subcutaneous tissue. The main bacteria responsible for cellulitis are
Streptococcus and Staphylococcus ("staph"), the same bacteria that can cause...
