What is Pilonidal cyst?
A pilonidal cyst is an abnormal pocket in the skin that usually contains hair and skin debris. A pilonidal cyst is almost always located near the tailbone at the top of the cleft of the buttocks.
Pilonidal cysts usually occur when hair punctures the skin and then becomes embedded. If a pilonidal cyst becomes infected, the resulting abscess is often extremely painful. The cyst can be drained through a small incision or removed surgically.
Pilonidal cysts most commonly occur in young men, and the problem has a tendency to recur. People who sit for prolonged periods of time, such as truck drivers, are at higher risk of developing a pilonidal cyst.
Pilonidal cyst Risk factors
The following factors increase your chance of developing a pilonidal cyst:
- Personal or family history of similar problems such as acne, boils, carbuncles, folliculitis, and sebaceous cysts
- Large amounts of hair in the region
- Tailbone injury
- Horseback riding, cycling
- Prolonged sitting
Causes of Pilonidal Cyst
Activities like sitting cause friction and prompt the growing hair in the buttocks, into going back into the skin. When hair retracts back to the skin, the body considers hair as foreign particles and launches an immune response against the hair.
Because of this immunization process, a cyst gets formed around the hair. Although the root cause for pilonidal sinus has not been established for certain, the factors that contribute to it are:
- Changing of hormones after puberty
- Growth of hair
- Friction from clothes
- Spending a lot of time sitting
Pilonidal cyst symptoms
If a pilonidal cyst is not infected, there may be no symptoms. When a cyst is infected, signs and symptoms include
- Pain to the top of the buttocks,
- Low back pain,
- Discharge of blood or pus (if abscess ruptures or “pops”), and
- Foul-smelling odor.
Complications of Pilonidal Cyst
There are a number of complications that may arise from pilonidal cysts. These include wound infection and a recurrence of the pilonidal cysts even after surgery.
Signs that the wound is infected include:
- Severe pain
- Inflamed swollen skin
- A temperature of 100.4°F or higher
- Blood and pus seeping from the wound site
- A foul odor coming from the wound
Diagnosis and test
A diagnosis of Pilonidal Cyst may involve the following:
A thorough medical history and physical examination: In many cases, Pilonidal Cyst is diagnosed based on the presenting symptoms and no further lab tests may be necessary
- Blood tests
- Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnifying lens
- Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
- Culture studies of the fluid being drained
- Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
Treatment and medications
Most pilonidal cysts are left alone. But if a cyst becomes infected, treatment is needed. It may include the following:
Incision and drainage: If needed, the cyst is cut open, and pus and other infected material are allowed to drain.
Antibiotic medicines for the infection: Know that medicines do not make the cyst go away, and antibiotics have limited use in treating an abscess. They also won’t keep a cyst from becoming infected again.
Hot water soaks: These can help draw out the infection and ease pain and itching.
Surgery to remove the cyst (excision): This may be done if the infection is severe, does not respond to medicine, or keeps coming back. A surgeon cuts and removes the cyst and the tissue around it. Your healthcare provider can tell you more if this is needed.
Laser hair removal around the area: This may decrease the frequency of flare-ups.
Types of Pilonidal Cyst Surgery
There are numerous ways on how to remove a pilonidal cyst or help speed up its healing process. Some surgeons recommend completely removing the cyst to stop it from filling up with fluids again. Although this might be logically sound, it may also have physical repercussions. Some of the options that you can choose from are:
Lancing: Draining a pilonidal cyst may be done by making a small incision into the abscess, allowing the pus and other debris to drain out of the cyst. Once all the liquid is removed, the cyst is then packed with sterile gauze. However, 85 percent of patients who get their cysts drained suffer from the condition again as the cavity fills up with debris again.
Marsupialization: Doctors cut a slit on the portion of skin that covers the cyst. The edges of the wound are then sutured down to the base of the wound. This will leave the wound open to heal. Patients who choose this type of removal will need longer recovery time. This will also leave a sizeable dent in the sacral area.
Incision and drainage: The cyst is removed, but the wound will not be closed. This will let it heal on its own, which will normally take about two months.
Incision, drainage, closing of wound: This entails the draining of the cyst and the wound is closed by the surgeon.
Cleft lift: Cleft lifting consists of a doctor making the natal cleft where pilonidal cysts usually grow shallower. This will lower the chance of debris and moisture build-up.
Once this infection has healed, the following may decrease the risk of future infections:
- Keep the area of the cyst clean by bathing or showering daily.
- Avoid tight-fitting clothing to minimize perspiration and irritation of the skin.
- Recurrent pilonidal cysts may be completely removed by surgery. But this can only be done at a time when there is no infection. Ask your doctor for more information.