A pilonidal cyst develops in the tissue over the tailbone, near the cleft of the buttocks. These cysts usually contain hair and skin debris. Patients with a pilonidal cyst may develop an infection with associated pain and inflammation. The treatment and management of pilonidal cysts depend on many factors, including the extent and nature of the disease. Recurrence of pilonidal cysts (when they are not treated surgically) is common, and is estimated to occur in approximately 40%-50% of patients.
Most researchers believe that pilonidal cysts are acquired (rather than inborn) and that they are caused by the penetration of loose hairs into the skin through dilated hair follicles. In response to this ingrown hair, a local inflammatory reaction causes a cystic structure to form around the hair and the other skin debris. Excessive pressure or repetitive injury to the tailbone area is thought to predispose patients to develop a cyst or to irritate an already existing pilonidal cyst.
Risk factors for the development of pilonidal cysts include male gender, a family history of pilonidal cysts, obesity, occupations that require prolonged sitting, excessively hairy individuals, and the presence of a deep natal cleft (the cleft between the buttocks). Pilonidal cysts are very common among young athletic men. Patients who simply have a dimple or sinus tract that has not become infected or inflamed do not require any treatment.
If the pilonidal cyst becomes infected, an abscess may form. The following signs and symptoms may develop:
- Drainage of pus from an opening in the skin
If these problems develop, please contact your physician as soon as possible.
Pilonidal Cyst Treatment
An infected pilonidal cyst may become a pilonidal abscess that requires surgical drainage. This procedure can generally be performed in a physician's office or in the emergency department. This involves numbing the area with local anesthetic and making a small incision to allow the infection to drain. Very commonly there is packing material placed in the wound which is removed over several days. Warm sitz baths (soaking in warm water) are very hellpful in the recovery of this problem.
For those patients with recurrent, complicated, or chronic pilonidal disease, more invasive surgery to excise the sinus or cysts may be necessary. Several surgical procedures are available, and your surgeon will discuss the best options with you. Most commonly we perform a pilonidal cystectomy, with excision of the entire pilonidal cyst, including the midline pits or dimple.
Following surgery, pilonidal wounds are usually left open. This prevents serious infections and helps speed recovery. The best treatment is to take sitz baths (soaking in a tub of warm water) 2 – 4 times or more daily. (If you don’t have a bath, showers can be used). This keeps the wound clean and helps draw out any infection. It is also very soothing for the patient. The best dressings are women’s panty liners which can be purchased at any grocery. These should be changed at least 2-4 times daily or as needed. An open pilonidal wound may take up to 8 weeks to completely heal.