A pilonidal cyst is an abnormal skin growth that is filled with air or fluid, commonly located in the crease of the buttocks. Pilonidal cysts are connected to our skin through sinus tracts and usually contain nests of very fine shed hair. Pilonidal cysts are not ingrown hairs (pilonidal hair do not have any follicles attached to them) and are not caused by skin infections. Pilonidal cyst infections can be either acute or chronic and, if left untreated, can lead to sepsis, more complex abscesses (pockets of pus trapped beneath the skin), and an increased number of sinus tracts (empty pockets of air underneath the skin). Due to the fact that pilonidal cysts occur around or just above the tailbone, they can result in extreme discomfort, especially when sitting. Although they can be painful, pilonidal cysts are not contagious, meaning that they cannot be spread from person to person.
Causes of Pilonidal Cysts
Anyone can get a pilonidal cyst, but certain individuals are at higher risk. Men, young adults under the age of 40, and overweight people are all more susceptible to developing a pilonidal cyst. People who sit for extended periods of time, such as truck drivers and office workers, are more susceptible to symptoms from infected pilonidal cysts. Also at risk are those with particularly deep gluteal clefts or a significant amount of very fine hair in the region. Wearing tight clothing can also contribute to the development of pilonidal cysts. In some instances, pilonidal cysts can have a genetic component.
Many medical professionals believe that pilonidal cysts are primarily caused by shed hair that congregates in the gluteal cleft and tunnel under the skin with friction resulting from our normal motion The fine hair nests encountered within the Pilonidal Cysts do not contain hair follicles confirming that they are not ingrown hair.
Symptoms of a Pilonidal Cyst
Common symptoms of a pilonidal cyst include pain that intensifies when sitting, a small dimple in the skin, or a large swollen area between the buttocks. A pilonidal cyst can also present as a small pit on the surface of the skin. A pilonidal abscess may drain pus or blood and be accompanied by a foul-smelling odor. In some cases, nausea, fever, and fatigue can also be symptoms of a pilonidal cyst.
Pilonidal Cyst Diagnosis
To diagnose a pilonidal cyst, a doctor will typically give the patient a full physical examination, as the pilonidal cyst should be visible to the naked eye. The medical provider might also ask if there are accompanying symptoms if the cyst has changed in appearance over time, whether or not it has been draining fluid, and what medications the patient is currently taking. In some rare instances, a doctor may require a CT or an MRI to examine any pilonidal sinus cavities that may have developed under the surface of the skin and to rule out any deeper connections as would be observed in presacral masses
Prevention of Pilonidal Cysts
In order to prevent the occurrence of pilonidal cysts, the buttocks area should be regularly washed and thoroughly dried with a clean towel, in order to keep the entire area clean. It is also essential to avoid sitting for long periods of time if possible. Removing the hairs surrounding the buttocks through conventional methods such as shaving or depilatories can prevent hair from growing, irritating the cyst, or developing more sinus tracts. Overweight individuals may benefit from losing weight in order to lower their risk of developing a pilonidal cyst abscess.
Pilonidal Cyst Treatment
The treatment of pilonidal cysts can be influenced by several factors, including whether or not the patient has experienced infection of a pilonidal cyst before and if there are other skin issues present in the same tissue as the cyst.
One method of treatment is incision and drainage of the pilonidal cyst. In this procedure, a small incision is made on the surface of the skin in order to drain fluid from the infected cyst. If the skin and tissue around the cyst is infected, antibiotics can treat skin inflammation, but antibiotics cannot heal pilonidal cysts by themselves. Laser hair removal can remove hair in the buttocks region that might otherwise lead to more pilonidal cysts and sinuses in the future. Warm compresses can provide temporary relief from the pain associated with pilonidal cysts.
To treat an infected pilonidal cyst, the initial management technique utilized is surgical drainage followed by a course of antibiotics. Once the initial infection has been resolved, the cyst can be excised by the application of one of many surgical procedures, including primary closure, flap closure, and marsupialization. These procedures carry varying risks, benefits, and recurrence rates. If the surgical wound is left open, it can take several weeks to heal properly. The benefit of leaving the cyst open is that it often results in the best cosmetic outcome, and it has the least recurrence rate.
At RS Surgical, we discuss these procedures in detail with our patients in order to provide them with as much accurate health information as possible so that they can make an informed decision about their treatment.