Pilonidal cyst
A pilonidal cyst is a fluid-filled defect that occurs at the base of the spine, often referred to as the tailbone area. This condition can present in various stages, including a non-infected cyst, an abscess (which contains pus), and a sinus (an opening connecting the cyst to the surface). While typically harmless, pilonidal cysts can become problematic if infected, leading to symptoms such as pain, foul odor, and drainage. The risk of developing a pilonidal abscess is particularly higher in young Caucasian men with excessive hair in the region, as well as individuals with a history of similar skin issues or those involved in activities like horseback riding and cycling.
Diagnosis involves a physical examination by a healthcare provider, who may refer the patient to a surgeon for treatment. Treatment options vary based on the severity, ranging from hot water soaks to professional interventions like incision and drainage, or more extensive surgical procedures to remove affected tissue. Preventative measures include maintaining cleanliness and dryness in the area, as well as managing hair growth. While the condition is not serious, it can cause significant discomfort, making awareness of symptoms and risk factors important for those affected.
Pilonidal cyst
- ANATOMY OR SYSTEM AFFECTED: Skin
- ALSO KNOWN AS: Pilonidal abscess, pilonidal sinus
Definition
A pilonidal cyst is a fluid-filled defect found at the base of the spine, or tailbone area. The different stages of the disease process are referred to by the terms “cyst” (not infected), “abscess” (pocket of pus), and “sinus” (an opening between a cyst or other internal structure and the outside).
When a pilonidal cyst is infected, it forms an abscess, eventually draining pus through a sinus. Pilonidal cysts are harmless until they get infected. At this point they form an abscess that causes pain, a foul smell, and drainage. This is more likely to occur in young Caucasian men with a large amount of hair in the region of the tailbone. This condition is not serious, but because it is an infection similar to a boil or carbuncle, it can enlarge and become uncomfortable.
Causes
A pilonidal condition may be congenital or acquired. If congenital, it probably began as a defect that existed when the person was born. Sometime later, the defect allowed an infection to develop. An acquired pilonidal condition may be caused by the enlargement of a simple hair follicle infection or by a hair penetrating the skin and causing an infection.
Risk Factors
The factors that increase the chance of developing a pilonidal abscess are personal or family history of similar problems (such as acne, boils, carbuncles, folliculitis, or sebaceous cysts), large amounts of hair in the region, a tailbone injury, horseback riding, and cycling. Individuals who are overweight, regularly sit for long periods at a time, or have an inactive lifestyle are also at increased risk of developing pilonidal cysts.
Symptoms
The symptoms that indicate a pilonidal abscess that needs to be treated by a doctor are painful swelling over the sacrum (just above the tailbone), a foul smell, and pus draining from the area.
Screening and Diagnosis
A doctor will ask about symptoms and medical history and will perform a physical exam. The infected person will then be referred to a surgeon for treatment. No diagnostic tests are required.
Treatment and Therapy
The choice of treatment will depend on the extent of the condition and the person’s general, overall health. As with all localized infections under the skin, hot water soaks will draw out the infection. This will not completely cure the condition, but it will help.
Another treatment option is incision and drainage, in which the abscess is sliced, the pus is drained, and the wound is packed with sterile gauze. This helps the wound heal from the inside out. However, this usually does not cure the problem because abnormal tissue remains. To completely cure the condition, all affected tissue needs to be removed. This is an extensive surgical procedure that involves more than simple incision and drainage. The surgical wound may be closed with sutures or left open to heal from the inside. Also, reports suggest that laser hair removal in the area may be an effective treatment for pilonidal cysts.
Prevention and Outcomes
To reduce the chance of getting a pilonidal abscess, one should keep the area clean and dry, avoid sitting for long periods of time on hard surfaces, and remove hair from the area.
Bibliography
Humphries, Ashley E., and James E. Duncan. “Evaluation and Management of Pilonidal Disease.” In Anorectal Disease, edited by Scott R. Steele. Philadelphia: Saunders, 2010.
Icon Health. Abscess: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, Calif.: Author, 2004.
"Pilonidal Cyst." Mayo Clinic, 4 Oct. 2024, www.mayoclinic.org/diseases-conditions/pilonidal-cyst/symptoms-causes/syc-20376329. Accessed 4 Feb. 2025.
Sadick, N. S., and J. Yee-Levin. “Laser and Light Treatments for Pilonidal Cysts.” Cutis 78 (2006): 125-128.
Velasco, Alfonso L., and Wade W. Dunlap. “Pilonidal Disease and Hidradenitis.” In Skin Surgery and Minor Procedures, edited by Frederick Radke. Philadelphia: Saunders/Elsevier, 2009.
Weedon, David. Skin Pathology. 3d ed. New York: Churchill Livingstone/Elsevier, 2010.