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.
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.
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.
Risk factors for pilonidal cysts include the following:
If a pilonidal cyst is not infected, there may be no symptoms. When a cyst is infected, signs and symptoms include
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.
More Health News »Home remedies are aimed at relieving pain and swelling. These home treatments include the following:
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.
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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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.
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.
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).
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