Pilonidal Cyst Treatment, Complications, and Prevention

  • Medical Author:
    Steven Doerr, MD

    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.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    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.

How is a pilonidal cyst diagnosed?

A pilonidal cyst can be diagnosed by your health-care professional based on your symptoms and the findings on your physical exam. No blood work or imaging studies are usually necessary to make the initial diagnosis.

What is the treatment for a pilonidal cyst?

For those individuals who have a dimple or sinus tract without symptoms and that has not become infected, no immediate treatment is necessary. However, if there are any signs or symptoms of an infected pilonidal cyst (pilonidal abscess), then incision and drainage is necessary. To prevent recurrence, excision or removal of the cyst is necessary. While a simple incision and drainage may be performed in a physicians office or emergency room, generally speaking, excision is usually performed in the operating room using local or other types of anesthesia.

  • Using sterile technique and after placing the patient in the prone (facedown) position, the infected area is numbed with an injection of local anesthetic.
  • Using a scalpel, a longitudinal elliptical incision is made into the skin off the midline to drain the pus, and remove hair and any other debris from the wound and excise the cyst wall.
  • The wound is packed with ribbon wound packing in order to allow continued drainage and then dressed and allowed it to heal.

Antibiotics are not necessary unless your physician feels that you have a spreading skin infection (cellulitis). Pain medication will often be prescribed. You will then need to follow up with your health-care professional in a timely manner to ensure proper wound healing and to monitor for any potential complications. The ribbon wound packing may be removed by your health-care professional if there is no continued purulent drainage. Otherwise, treatment at home will consist of pain control, wound care, and cleansing of the wound using warm shower water or Sitz baths once the packing has been removed. The skin wound will eventually close and heal on its own, and keeping the area clean and free of any hair will help prevent the recurrence of pilonidal disease. If you encounter any signs or symptoms of continued infection, or if the wound fails to heal, prompt follow-up should be arranged with your health-care professional. In the majority of cases, the wound heals completely in approximately one month.

For those individuals with recurrent, complicated, or chronic pilonidal disease, more invasive surgery may be necessary in an operating room. Several different surgical techniques may be used, and your surgeon will discuss the various options with you. In general, the major difference in surgical techniques involves either leaving the surgical wound open after surgery and allowing it to heal (requiring a longer healing time but having a lower recurrence rate) versus closing the surgical wound after debridement during the surgery itself (with a shorter healing time but higher recurrence rate). Another surgical technique involves suturing the skin edges of the wound and allowing the open wound to slowly heal (marsupialization). Healing time and recovery vary based on the surgical technique used and may range from several weeks to several months. Finally, the treatment of pilonidal disease using a series of phenol injections is another alternative to surgery alone, although this option is more commonly used in Europe than in the United States. Follow-up with your surgeon should be arranged after your procedure, and meticulous wound care and hygiene are necessary to ensure proper wound healing and to prevent recurrence.

What are the complications of a pilonidal cyst?

The complications of a pilonidal cyst may include the following:

  • Abscess formation
  • Recurrence of the pilonidal cyst
  • Systemic infection (infection that spreads throughout the body)
  • Rarely, squamous cell carcinoma (the development of a form of skin cancer within the cyst)

How are pilonidal cysts prevented?

Good hygiene of the sacrococcygeal area is important to help prevent the development of pilonidal disease and its recurrence if it does develop. Keep the area clean and dry, and either shave or use depilatory creams to keep the area free of hair. Also, try to avoid prolonged sitting or excessive repetitive pressure to the area of the coccyx (tailbone). Weight loss in obese individuals may also help decrease the development and recurrence of pilonidal disease.

What is the prognosis for pilonidal cysts?

Generally speaking, the prognosis for individuals with pilonidal disease is excellent. Recurrence of pilonidal disease, however, is common and is generally estimated to occur in between 40%-50% of individuals.

Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care

REFERENCES:

de Caestecker, James. "Pilonidal Disease." Medscape.com. Aug. 24, 2009. <http://emedicine.medscape.com/article/192668-overview>.

Lanigan, Michael D. "Pilonidal Cyst and Sinus." Medscape.com. Aug. 6, 2009. <http://emedicine.medscape.com/article/788127-overview>.

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Reviewed on 3/3/2017 12:00:00 AM