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Pilonidal cyst
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/pilonidal-cyst/DS00747
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Definition
A pilonidal cyst is an abnormal pocket originating in the skin that usually contains hair, skin debris and other abnormal tissue. A pilonidal cyst is almost always located near the tailbone at the top of the cleft of the buttocks. The term "pilonidal" comes from the Latin words for hair ("pilus") and nest ("nidus").
Pilonidal cysts affect men more often and most commonly occur in young adults.
A pilonidal cyst may remain harmless. If it becomes infected, however, it will cause pain, inflammation and usually drainage of fluids.
Symptoms
A pilonidal cyst may cause no noticeable symptoms (asymptomatic). The only sign of its presence may be a small pit on the surface of the skin.
When it's infected, a pilonidal cyst becomes a swollen mass (abscess). Signs and symptoms of an infected pilonidal cyst include:
- Pain
- Localized swelling
- Reddening of the skin
- Drainage of pus or blood from an opening in the skin (pilonidal sinus)
- Foul smell from draining pus
- Hair protruding from a passage (tract) below the surface of the skin that connects the infected pilonidal cyst to the opening on the skin's surface (a pilonidal sinus) — more than one sinus tract may form
- Fever (uncommon)
When to see a doctor
If you notice any signs or symptoms of a pilonidal cyst, see your doctor. He or she can diagnose the condition by examining the lesion.
Causes
There is some disagreement about what causes pilonidal cysts. Most pilonidal cysts appear to be caused by loose hairs that penetrate the skin. Friction and pressure — skin rubbing against skin, tight clothing, bicycling, long periods of sitting or similar factors — force the hair down into skin. Responding to the hair as a foreign substance, the body creates a cyst around the hair.
This explanation accounts for rare cases of pilonidal cysts that occur in parts of the body other than near the tailbone. For example, barbers, dog groomers and sheep shearers have developed pilonidal cysts in the skin between fingers.
Another possible explanation is that normal stretching or motion of deep layers of skin causes the enlargement and rupture of a hair follicle, the structure from which a hair grows. A cyst then forms around the ruptured follicle.
Some children are born with a small indentation in the skin (sacral dimple) near the top of the cleft of the buttocks. Rarely, a sacral dimple may become infected, essentially forming a pilonidal abscess.
Risk factors
Certain factors can make you more susceptible to developing pilonidal cysts. These include:
- Obesity
- Inactive lifestyle
- Occupation or sports requiring prolonged sitting
- Excess body hair
- Stiff or coarse hair
- Poor hygiene
- Excess sweating
Complications
If a chronically infected pilonidal cyst isn't treated properly, there may be an increased risk of developing a type of skin cancer called squamous cell carcinoma.
Preparing for your appointment
You're likely to start by seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a dermatologist or a surgeon.
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any recent life changes.
- Make a list of all medications, as well as any vitamins or supplements, that you're taking.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. For a pilonidal cyst, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- Other than the most likely cause, what are possible causes for my symptoms or condition?
- Is my condition likely temporary or chronic?
- What is the best course of action?
- What are the alternatives to the primary approach that you're suggesting?
- I have these other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
What you can do in the meantime
Avoid wearing tightfitting clothing in order to lessen skin irritation. Keep the infected area as clean and dry as possible, and try not to sit for long periods.
Treatments and drugs
Treatment for an infected pilonidal cyst may include:
The initial treatment for an infected pilonidal cyst, or pilonidal abscess, is usually a procedure performed by your primary care doctor or a surgeon. You're given a local anesthetic to numb the area before your doctor opens the abscess, drains the fluids, and removes hair and other debris. The wound is packed with dressing so that it can heal from the inside out. For up to 60 percent of people with an infected pilonidal cyst, this treatment is effective and no further treatment is needed.
Surgery
A surgical procedure is necessary if you have a recurring infected pilonidal cyst or if one or more sinus tracts are present. A surgeon will expose the cysts and all sinus tracts in order to clean out hairs, pus and other debris. The preferred surgical procedures generally fall into two categories:
- Open wound. The surgical wound is left open and packed with dressing to allow it to heal from the inside out. This process results in a longer healing time but usually a lower risk of a recurring pilonidal cyst infection.
- Closed wound. After cleaning out the cyst and sinus tracts, the surgeon stitches the wound closed. The healing time is shorter with these procedures, but there is a greater risk of recurrence. To improve healing time and lower the risk of recurrence, the surgeon may make the incision off to one side and create a flap of skin. Therefore, when he or she stitches the wound, it is not in the cleft of the buttocks, where healing is particularly difficult.
Wound care is extremely important after surgery. Your doctor or nurse will give you detailed instructions on how to change dressings, what to expect of a normal healing process and when to call the doctor. Postoperative care will also include shaving around the surgical site to prevent hairs from entering the wound.
Prevention
To prevent future pilonidal cysts from developing:
- Clean the area daily with glycerin soap, which tends to be less irritating. Rinse the area thoroughly to remove any soapy residue. Washing briskly with a washcloth helps keep the area free of hair accumulation.
- Keep the area clean and dry. Powders may help, but avoid using oils or herbal remedies.
- Avoid sitting for long periods of time.
- Humphries AE, et al. Evaluation and management of pilonidal disease. The Surgical Clinics of North America. 2010;90:113.
- Sullivan DJ, et al. Pilonidal disease. http://www.uptodate.com/home/index.html. Accessed March 18, 2010.
- AL-Khamis A, et al. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database of Systematic Reviews. 2010:CD006213.
- Pilonidal disease. American Society of Colon and Rectal Surgeons. http://www.fascrs.org/patients/conditions/pilonidal_disease/. Accessed March 16, 2010.
- Bullard Dunn KM, et al. Colon, rectum and anus. In: Brunicardi FC, et al. Schwartz's Principles of Surgery. 9th ed. New York, N.Y.: The McGraw-Hill Companies; 2010. http://www.accessmedicine.com/content.aspx?aID=5015668&searchStr=pilonidal+cyst#5015668. Accessed March 17, 2010.
- Gibson LE (expert opinion). Mayo Clinic, Rochester, Minn. March 22, 2010.
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