- Pilonidal Cyst
- Patient Education
- Infected Pilonidal Cyst (Incision & Drainage)
- Home care
- Follow-up care
- When to seek medical advice
- Pilonidal Cyst
- What Causes Pilonidal Cysts?
- What Are the Symptoms of Pilonidal Cysts?
- How Are Pilonidal Cysts Treated?
- What Causes a Rash on the Butt?
- Contact dermatitis
- Atopic dermatitis (eczema)
- Heat rash
- Genital herpes
- Keratosis pilaris
- Ringworm (jock itch)
- Lichen sclerosus
- Folliculitis (butt acne)
- Candida (yeast) skin infection
- What Is a Pilonidal Cyst?
- Pilonidal Cyst Causes
- Symptoms and Diagnosis
- Pilonidal Cyst Treatment
- Pilonidal Cyst Surgery
- Pilonidal Cyst Home Treatment
- Pilonidal disease
- What is pilonidal disease?
- What causes pilonidal disease?
- Who gets pilonidal disease?
- What are the signs and symptoms?
- How is the diagnosis made?
- What treatment is available?
A pilonidal cyst is a fluid-filled developmental defect at the base of the spine.
The terms cyst, sinus, and abscess refer to different stages of the disease process.
- Cyst — not infected
- Abscess — pocket of pus
- Sinus — opening between a cyst or other internal structure and the outside
While the cyst is not serious, it can become an infection and should therefore be treated. When a pilonidal cyst gets infected, it forms an abscess, eventually draining pus through a sinus. The abscess causes pain, a foul smell, and drainage.
This condition is not serious. But, since it is an infection, it can enlarge and become uncomfortable. Therefore, it should be treated.
Pilonidal Cyst Copyright © Nucleus Medical Media, Inc.
A pilonidal cyst may be congenital or acquired. If congenital, it probably began as a defect that existed when you were born. Sometime later, the defect allowed an infection to develop. If acquired, it may be the enlargement of a simple hair follicle infection or the result of a hair penetrating the skin and causing an infection.
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
Symptoms may include:
- Painful swelling over your sacrum, which is the area just above your tailbone
- A foul smell or pus draining from that area
Your doctor will ask about your symptoms and medical history. A physical exam will be done. You will be referred to a surgeon for treatment. There are no diagnostic tests required.
Talk with your doctor about the best treatment plan for you. The choice of treatment will depend on the extent of the condition and your general overall health. Treatment options include:
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.
Incision and Drainage
The abscess is lanced, the pus drained, and the wound is packed with sterile gauze. This helps it heal from the inside out. But, 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 a more extensive surgical procedure than simple incision and drainage. The surgical wound may be closed with sutures or left open to heal from the inside.
Laser Hair Removal
There are recent reports that laser hair removal in the area may be an effective treatment for pilonidal cysts.
Here are ways to reduce your chance of getting a pilonidal abscess:
- Keep the area clean and dry.
- Avoid sitting for a long time on hard surfaces.
- Remove hair from the area.
Antibiotics do not heal a pilonidal cyst. But doctors have any number of procedures they can try. Here are some options:
Incision and drainage: This is the preferred method for a first pilonidal cyst. Your doctor makes a cut into the cyst and drains it. He removes any hair follicles and leaves the wound open, packing the space with gauze.
Advantage — It’s a simple procedure done under local anesthesia, meaning just the area around the cyst is numbed.
Disadvantage — You have to change the gauze often until the cyst heals, which sometimes takes up to 3 weeks.
Marsupialization: In this procedure, your doctor makes a cut and drains the cyst, removing pus and any hair that are inside. He’ll sew the edges of the cut to the wound edges to make a pouch.
Advantages — This is outpatient surgery under local anesthesia. It also lets the doctor make a smaller, shallower cut so that you don’t need to take out and repack gauze daily.
Disadvantages — It takes about 6 weeks to heal, and you need a doctor specially trained in the technique.
Incision, drainage, closing of wound: In this technique, the cyst is drained, but it’s not left open.
Advantage — You don’t need to pack gauze because your doctor fully closes the wound right after surgery.
Disadvantages — You’re more likely to have more problems with the cyst down the road. It’s harder to remove the entire cyst with this method. It’s usually done in an operating room with a specially trained surgeon.’
Other surgical procedures include complete cyst and cyst wall excision along with the pilonidal sinus tracts, the use of fibrin glue, and taking (core out) only diseased tissue and the cyst out with punch biopsies.
Infected Pilonidal Cyst (Incision & Drainage)
A pilonidal cyst is a swelling that starts under the skin on the sacrum near the tail bone. It may look like a small dimple. It can fill with skin oils, hair, and dead skin cells. It may stay small or grow larger. Because it often has an opening to the surface, it may become infected with normal skin bacteria.
The cause of pilonidal cysts has been debated since they were first recognized. It may be present at birth and go unnoticed. Injury, rubbing, or skin irritation may also cause pilonidal cysts. It can also be caused by an ingrown hair. Most likely, the cause is a combination of these things. Because some injury or irritation can lead to pilonidal cysts, it can be more common in people who sit or drive a lot for work.
A pilonidal cyst may be small and painless. If it is inflamed or infected, you may have these symptoms:
Irritation or redness
The cyst can swell and drain on its own. The swelling and drainage can come and go.
Your pilonidal cyst was drained with a small incision using local anesthesia.
After the incision and drainage, gauze packing may be inserted into the opening. If so, it should be removed in 1 to 2 days. Antibiotics are not required in the treatment of a simple abscess, unless the infection is spreading into the skin around the wound. The wound will take about 1 to 2 weeks to heal depending on the size of the cyst.
Pus may drain from the wound for the first few days. Cover the wound with a clean dry bandage. Change the bandage if it becomes soaked with blood or pus, or if it gets soiled with feces or urine.
Sit in a tub filled with about 6 inches of hot water. Keep the water hot for 10 to15 minutes.
If gauze packing was placed inside the cyst cavity, you may be told to remove it yourself. You may do this in the shower. Once the packing is removed, you should wash the area carefully in the shower once a day. Do this until the skin opening has closed. It is okay to direct the shower spray directly into the opening if this is not too painful.
Take acetaminophen or ibuprofen for pain, unless you were given a different pain medicine to use. Talk with your doctor before using these medicines if you have chronic liver or kidney disease or have ever had a stomach ulcer or gastrointestinal bleeding. Also talk with your doctor if you are taking blood thinner medicines.
If you were given antibiotics, take them until they are gone. It is important to finish the antibiotics even if the wound looks better. This is to make sure the infection has cleared.
Use antibiotic cream or ointment if your healthcare provider tells you to do so.
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.
Follow up with your healthcare provider, or as advised. If a gauze packing was inserted in your wound, it should be removed in 1 to 2 days. Check your wound every day for the signs listed below.
When to seek medical advice
Call your healthcare provider right away if any of these occur:
Pus continues to come from the cyst for 5 days after the incision
Increasing redness, local pain, or swelling
Fever of 100.4°F (38.0°C) or higher for more than 2 days, or as directed by your healthcare provider
What is a tailbone cyst?
A tailbone cyst is an abnormal saclike structure in the skin. It usually happens in the crease between the buttocks, near the tailbone. It often contains hair and small pieces of skin. It can get infected and cause an abscess, which is a pocket of infected fluid (pus) with a thick wall around it.
A tailbone cyst is also called a pilonidal cyst.
What is the cause?
These cysts seem to be caused most often by an ingrown hair. A hair grows back under the skin or skin grows over a hair. This might happen, for example, because of pressure or friction, like when you have been sitting or riding a bicycle for a long time. The ingrown hair irritates the skin and causes a cyst to form around the hair.
You may be more likely to have a pilonidal cyst if you were born with a little dimple in the skin between the buttocks. For reasons that are not well understood, the dimple can tend to get infected.
What are the symptoms?
Common symptoms are:
- Pain when you are sitting
- Redness and swelling in the area of your tailbone in or just above the crease between your buttocks
- Pus oozing from the swollen area
- Tenderness when the swollen area is touched
- Sometimes fever, weakness, or nausea
The size of the pilonidal cyst may range from a small tender dimple to a large painful area.
How is it diagnosed?
Your healthcare provider will ask about your symptoms and medical history and examine you.
How is it treated?
If the cyst is infected, usually it needs to be drained by your healthcare provider. This treats the infection and gets rid of the pressure that causes pain. It can be done in your provider’s office. Even if the cyst is not infected, opening it and draining it is recommended to relieve pain and prevent infection. In some cases your provider may remove the whole cyst.
A problem called a chronic pilonidal sinus can happen after a cyst has been drained. A pilonidal sinus is a space under the skin that forms where the cyst used to be. The sinus connects to the skin with one or more small openings. The problem with the sinus is that it can keep getting infected. In some cases the sinus may heal and close by itself, but usually the sinus has to be cut out. The sinus area may be stitched shut after the sinus is removed or it may be left open to drain and heal from the inside out.
Your provider will discuss your choices for treatment.
A problem called complex or recurrent pilonidal disease is a complication of a pilonidal cyst. It may happen if:
- The area of the first abscess keeps getting infected again.
- You have hair growing in the area of the scar.
- The area gets sweaty and rubbed a lot.
- You have a sinus that was not seen in earlier treatments.
In this case your healthcare provider must cut away the old wound, scar, and other inflamed tissue. This is a more extensive surgery than simple drainage of an abscess or removal of a sinus.
How can I take care of myself?
Before you see your healthcare provider for treatment, it can help to:
- Soak in a tub of warm water to lessen pain. Sometimes the cyst may open on its own.
- Keep the area clean and dry.
- Take nonprescription pain medicine to relieve pain.
After the cyst is drained:
- Make sure that you follow all of your healthcare provider’s instructions.
- Keep the area clean.
- Shave the area or use a hair removal cream every 2 to 3 weeks.
Follow your healthcare provider’s instructions. Ask your provider:
- How long it will take to recover
- What activities you should avoid and when you can return to your normal activities
- How to take care of yourself at home
- What symptoms or problems you should watch for and what to do if you have them
Make sure you know when you should come back for a checkup.
How can I help prevent a pilonidal cyst?
To help prevent another cyst:
- Keep the area between the buttocks and tailbone dry and clean.
- Keep hair out of the area by shaving or using a hair removal cream.
You can get more information from:
- The American Society of Colon and Rectal Surgeons1-847-290-9184http://www.fascrs.org
Individuals who simply have a dimple or sinus tract that has not become infected or inflamed do not generally require any immediate treatment. However, an infected pilonidal cyst may become a pilonidal abscess (pus containing structure) that requires incision and drainage (lancing) in order to improve. This procedure can generally be performed in a physician’s office or in the emergency department.
- This is done by numbing the area with a local anesthetic and making an incision with a scalpel over the infected area to open the abscess cavity.
- The pus is drained, and any accumulated hair and debris are removed. The wound is cleaned with saline solution, packed with gauze, and covered with a bandage.
- Antibiotics are generally not necessary unless signs of a spreading skin infection (cellulitis) are present. Pain medication will often be prescribed.
A follow-up with your physician in one to two days should be arranged to ensure adequate wound healing and to monitor for any potential complications. The wound packing will be removed by your physician, the wound will be examined, and repacking of the wound may be required if there is still purulent drainage. Treatment at home will consist of medications for pain control and diligent wound care. Sitz baths can be taken at home with warm water once the packing has been removed, and the skin wound will generally heal and close on its own in about four weeks. Keeping the wound area clean and removing any hair from around the sacrococcygeal area can help to prevent recurrence.
For those individuals with recurrent, complicated, or chronic pilonidal disease, more invasive surgery to excise the sinus or cysts may be necessary in a hospital operating room. Several different surgical procedures may be used in this case, and your surgeon will discuss the various options with you. In general, the major difference between the various surgical interventions centers around leaving the surgical wound open after surgery and allowing it to heal on its own, versus closure of the surgical wound after debridement during the surgery itself. Recovery time after surgery can take several weeks, and recurrence rates may vary depending on the choice of the surgical procedure. Potential postsurgical complications may include wound infection, poor wound healing, or recurrence.
The treatment of pilonidal disease using phenol injections is another alternative to surgery alone, although this option is more commonly employed in Europe than in the United States. Continued outpatient care and follow-up with your surgeon is necessary to ensure proper wound healing and to manage any potential complications or recurrence of pilonidal disease.
Pilonidal disease is a condition in which an abnormal pocket in the skin of the lower back is found, usually near the tailbone at the top of the cleft of the buttocks. The cyst may cause virtually no symptoms, with possibly only a bit of redness and swelling in the tailbone region — or it may become an open, infected wound that drains for years, causing irritation, pain and embarrassment.
The condition tends to be found chiefly in teenagers and young adults between 15- and 24-years-old (males more than females).
What Causes Pilonidal Cysts?
No one knows exactly what causes pilonidal disease. Some have proposed that hair follicles in the midline of the lower back get blocked and cause a cycle of inflammation and infection leading to abscess formation and a chronic wound. Others suggest that bits of hair from other parts of the body can get caught in a small opening in the skin of the lower back and cause this same cycle of inflammation and infection.
No matter the cause, patients with pilonidal disease can have multiple, recurring bouts of infection and discomfort. Some undergo repeat drainages of abscesses. Some undergo many surgeries in an attempt to remove the abscesses or cysts from the affected area. Too often, these operations fail to fully eradicate the disease.
What Are the Symptoms of Pilonidal Cysts?
- Pain at the site
- Swelling, redness
- Drainage of pus or blood from an opening in the skin; may be foul smelling
- Hair protruding from the cyst
- Fever (uncommon)
How Are Pilonidal Cysts Treated?
An active pilonidal abscess must be drained, and this can usually be done in the emergency room or the office under local anesthesia. After the urgent problem is addressed, a measured plan of action must be undertaken to prevent recurrence or worsening of symptoms. While antibiotics and warm soaks are often prescribed and may offer symptomatic relief, surgical removal of the problem is usually necessary.
Non-surgical approaches include the application of phenol or other scarring agents to eradicate the area of chronic inflammation and laser hair removal to avoid hair entrapment. The surgeons at Lurie Children’s do not recommend these approaches as primary, or sole, treatments.
The surgeons in the Division of Pediatric Surgery offer two approaches to pilonidal disease.
Where the only signs and symptoms have been an abscess and/or pain and swelling, the small open area at the base of the tailbone (the pilonidal pit) is removed under local anesthesia, either in the operating room or in the office. By eliminating the area where hair follicles can get blocked and cause inflammation and infection, most patients can avoid having further complications of pilonidal disease.
For open, chronic wounds and recurrent infections, more extensive surgeries are offered. One of the operations, known as the Bascom cleft lift procedure, was pioneered by two surgeons in Oregon for adult patients and has been adapted for children by a handful of pediatric surgeons across the US. The surgery, done under general anesthesia in the operating room, involves removing the affected tissue and covering the area with healthy tissue. A small suction drain is left under the skin to prevent swelling. The drain is removed two or three days after the surgery when patients come back for a postoperative visit. All procedures are done on an outpatient basis and take about 1–1½ hours.
What Causes a Rash on the Butt?
Here are a few of the common causes of rash on your buttocks:
Contact dermatitis is a common type of rash. It appears when your skin comes into contact with a substance that causes irritation to the skin. Some contact dermatitis rashes appear immediately, but most take some time to appear.
There are two types: allergic contact dermatitis and irritant contact dermatitis. Common symptoms of both include:
- redness and swelling
- severe itching
- dry, scaly, or cracked skin
- bumps and blisters
- oozing, crusty skin
- pain, burning, or tenderness
Common allergens and irritants include:
- plants, like poison ivy and poison oak
- medications, such as antibiotics or antihistamines
- chemical additives, including food flavorings, cosmetics, and perfumes
- cleaning products, such as soaps or laundry detergents
- bath or personal care products, including lotions, shampoo, soaps, and sunscreen
- fertilizers and pesticides
Atopic dermatitis (eczema)
Atopic dermatitis, which is generally known as eczema, is a chronic skin condition that causes itchy, dry skin. Eczema is most common in babies and children, but it can begin at any age.
Although eczema can cause rashes on the buttocks, they are typically seen:
- on the face
- on the elbows
- on the hands and feet
- dry, red, itchy patches of skin
- skin that weeps clear liquid when scratched
- crusty, scaly skin
- skin that turns red, swells, and itches more after scratching
Heat rash is a common skin irritation that causes redness and stinging. Your skin may feel prickly or itchy, and small bumps may form. Heat rash occurs most often, as its name implies, in hot, humid weather. Heat rash can also happen any time you sweat a lot.
When sweat gets trapped under your skin, it clogs up pores and causes small pimples to form. It typically occurs on parts of your body where skin rubs against skin, such as your butt crack or inner thighs.
Genital herpes is a common sexually transmitted virus that can cause rash-like symptoms on your buttocks, anus, or thighs. Herpes can be transmitted through any type of sexual contact, including vaginal, oral, or anal contact.
Rash symptoms originate in the place where the infection entered your body, but can spread when you scratch them. Symptoms include:
- pain or itching in your genital and anal area
- small red bumps
- small white blisters
- ulcers from oozing and bleeding
Keratosis pilaris is caused by a buildup of keratin on the skin. Keratin is a protein that protects your skin from harmful irritants and infections.
In people with keratosis, keratin forms a plug that blocks the openings of hair follicles. This causes rough, sandpaper-like skin. Tiny red bumps may form on the buttocks, though they are typically painless.
Shingles is an infection caused by the same virus that causes chickenpox. After you have chickenpox, the inactive virus remains in your body for years and can reactivate in adulthood. It typically appears as a painful rash on one side of the body. The rash may include:
- numbness, burning, pain, or tingling
- tenderness to touch
- blisters that break, causing crusty skin
You may also experience fatigue, general feelings of malaise, and fever.
Intertrigo is a rash that forms in the folds of the skin. When skin rubs against skin, it causes friction and creates a warm, moist environment that is ideal for fungal and bacterial growth.
Intertrigo is common in the skin between the buttocks (butt crack), which can become very raw, itchy, and painful. It may appear red or reddish-brown, and in severe cases the skin can crack, bleed, and produce a foul odor.
Psoriasis is a chronic, autoimmune skin condition. When you have psoriasis, your immune system mistakenly attacks your skin cells, causing them to grow rapidly and swell. The skin cell overgrowth forms a rash characterized by raised red marks and scaly white patches.
Psoriasis can cause a rash anywhere on the body, including the buttocks. Look for red or pink patches of raised skin that look cracked, scaly, and rough.
Ringworm (jock itch)
Ringworm is a fungal infection that can affect skin in several different parts of the body, including the following:
It can affect men, women, and children. Ringworm, which gets its name from the circular rash it produces on the skin, is often called jock itch or athlete’s foot, depending on its location.
- itchy red spots
- ring-shaped, circular rash
- scaly or cracked skin
- hair loss
Lichen sclerosus is a skin condition that most often affects the genital and anal area, but can affect other areas too. It’s most common among women who are postmenopausal, but it can affect men and children too.
- smooth, shiny, white spots
- redness, bruising, scales, or cracking
- skin that is thin and wrinkled or easy to tear
- bleeding and blistering
- itchiness and pain
- pain during urination, sex, or bowel movements
Folliculitis (butt acne)
People often mistake butt acne for regular acne. Pimples on your butt don’t form in clogged pores like facial acne. Instead, they form in clogged hair follicles.
In people with folliculitis, hair follicles become infected after being irritated, usually by friction or shaving. If you notice small, painful pimples on your butt or groin, they are probably infected with bacteria. These red bumps can be itchy and form whiteheads.
Candida (yeast) skin infection
Candida is a fungus that frequently infects the skin, often in warm, moist areas like the buttocks and groin. Candida is the most common cause of diaper rash in babies and adults.
People with diabetes, or who are obese or taking antibiotics, are at an increased risk. Yeast infections of the skin can occur in both men and women.
- intense itching
- red skin rash that grows
- small red bumps that look like pimples
People who have problems with bladder and bowel control often develop butt rashes. This is particularly true of adults who wear diapers, are bedridden, or are confined to a wheelchair for long periods of time.
Excess moisture between the buttocks and in the groin area provides an ideal environment for bacterial and fungal growth. Symptoms of incontinence-associated dermatitis include:
- redness and irritation
- pimply rash
Our tribe of runners tend to have a collective understanding about a few things. If you wear running shoes that are a tad too small, you’ll likely get a black toenail (or two). Foam rolling is king after double-digit weekend miles. Never, ever bandit a race. And sometimes, you’re get a nagging pain in the butt. No, not a running buddy that won’t stop talking during efforts, we’re talking about an actual discomfort in the backside.
Although there are many things that can contribute to pain in the right or left buttock cheek, which are made up of your glute muscles, piriformis syndrome is amongst the most common. The piriformis is a powerful, small muscle that sits deep behind the glutes and is responsible for external rotation of the hip joint. Next to the piriformis is the sciatic nerve. When the nerve gets irritated, either through repetitive activities like running or prolonged sitting, this causes a deep, dull pain.
“The sciatic nerve is a big bundle of nerves that supplies motor and sensory function from the hips all the way down to the toes,” says Blake Dircksen, C.S.C.S., doctor of physical therapy at Bespoke Treatments in New York City. “So when the nerve is chronically compressed, you may experience symptoms all the way down the leg.”
In a perfect world, the sciatic nerve is able to slide, glide, and bend with movements such as hip flexion and rotation. When it’s compressed, that mobility is compromised. Common symptoms include a deep burning or cramping in the glute or posterior thigh, tingling or a shooting pain down the leg, and discomfort with sitting on hard surfaces. The good news? There are a number of things that you can do to alleviate the pain.
In the short term, mix up your activity levels. So, if you feel sharp pain sitting or running—do the opposite. On a plane? Get up and walk around. Hitting a speed workout at the track when that zing kicks in? Slow down, and take some time off. Small tweaks, such as making an effort to minimize sitting time or using a soft cushion when sitting on hard surfaces and removing wallets from the back pocket can make a major difference, according to Dircksen.
Also, you may want to consider having an expert evaluate your gait, as excessive overpronation, or the inward movement of the foot when you land, has been shown to contribute to the issue, says exercise physiologist Susan Paul.
In the long term, it’s all about stretching and strengthening the piriformis and the surrounding muscles to help reduce muscle tension. Here, Dircksen outlines four techniques to counteracting piriformis syndrome:
1. Sciatic Nerve Flossing
Start sitting on the edge of a chair or bench so that the side that is bothering you is hanging off. Rest both feet flat on the floor. Bend the leg that is bothering you, point the toes, and draw the toes back behind you as you look up and back toward the ceiling. It’s okay to feel a slight amount of discomfort here. Next, straighten that knee and extend that leg out in front of you as you flex the toes. Reverse back to the starting position and repeat the motion with leg, but this time by tucking your chin to your chest. Return to starting poisiton. That’s one rep. Do 12 reps.
2. Figure Four Foam Rolling
Start sitting on a foam roller. Reach your left arm back, placing it a few inches behind you. Cross left ankle over right knee, creating a figure four position. Shift your weight slightly to the left hip area. Roll forward and back a few inches for about 30 to 60 seconds. Repeat on opposite side.
3. Dynamic Hamstring Stretch
Start in a runners lunge with your right foot forward, both hands on the floor framing your foot. Slowly straighten your right leg as much as possible, feeling a stretch up the back of the hamstring. Return back to start for one rep. Do 12 reps; repeat on other leg.
4. 90/90 External Rotation Stretch
Sit on the floor with the right leg bent at a 90-degree angle in front of you, with the outside of the right leg on the floor, right shin is parallel to shoulders, and thigh is extending straight forward from right hip. Position the left leg behind you, with knee bent at a 90-degree angle and the inside of the leg on the floor. Right heel and left knee should line up. Placing hands lightly on the floor on either side of the right leg, gently lean shoulders forward over right leg without rounding your back. Hold for 2 seconds. Sit up straight then lean back, placing hands lightly on the floor behind hips. Hold for 2 seconds. Continue leaning forward and back for 30 seconds.
Emily Abbate Emily Abbate is a freelance writer, certified fitness trainer, and host of the podcast Hurdle.
What Is a Pilonidal Cyst?
This type of cyst is common among truck drivers, barbers, and dog groomers.
A pilonidal cyst is an abnormal pocket or sac in the skin, usually occurring near the tailbone (coccyx), at the top of the buttocks crease.
Pronounced pie-low-NYE-dull, the word means ”nest of hairs.”
That’s because it can occur when hair penetrates the skin, becoming embedded and sometimes infected.
If the cyst becomes infected, the abscess that results can be very painful.
Pilonidal disease was recognized as long ago as the early 1800s. The cysts can range in size from very small to a large, painful mass.
Young men most often get these cysts, but they can occur in anyone.
In general, men are more likely than women to get the pilonidal cysts as adults.
However, in children, girls are more likely to be affected than boys.
Pilonidal Cyst Causes
Experts don’t agree on exactly what causes pilonidal cysts.
If you sit for prolonged periods, or wear tight clothing, you may be at higher risk of getting these cysts.
Some believe ingrown hairs (loose hairs that re-enter the skin) are the triggers. The skin then responds to the hair as if it was a foreign body and forms a cyst around it.
This chain of events helps explain pilonidal cysts that affect body parts other than the tailbone area.
For instance, the cysts can develop in the skin between the fingers among barbers and dog groomers.
Another theory has it that as the deep layers of the skin stretch, the hair follicle enlarges and ruptures.
A cyst forms around the follicle that is ruptured. The follicle is the structure from which a hair grows out.
Some experts believe pilonidal cysts occur after trauma to that body area.
Many World War II soldiers, for example, had pilonidal cysts. Experts blamed those cysts on the chronic irritation that occurred when the soldiers rode in Jeeps over bumpy terrain.
The condition was even known as “Jeep disease” for a time.
Some factors may increase the risk of getting a pilonidal cyst. Among them:
- Being obese
- Being inactive
- Working at a job that requires long sitting times
- Having excess body hair
- Having stiff or coarse hair
- Having poor hygiene
Symptoms and Diagnosis
Typically, your doctor can decide if you have a pilonidal cyst by simple examination.
The cyst may drain pus or other fluids. Sometimes, a pilonidal sinus develops. This is an opening that grows under the skin from the hair follicle.
Symptoms of pilonidal cyst infection include pain; skin reddening; and draining of pus or blood, sometimes with a foul smell. An infected cyst needs treatment.
If you don’t notice any symptoms from the cyst, and it isn’t bothering you, no treatment is typically needed.
However, some pilonidal cysts become swollen, tender, and infected.
Pilonidal Cyst Treatment
Your doctor will ask you if the cyst has changed in appearance, or if you notice any pain or drainage.
If treatment to drain the cyst is needed, it can typically be done in the doctor’s office or a same-day surgery center.
Your doctor will numb the area with an injection and then make a small incision, draining the cyst.
You may be given antibiotics so any infection won’t spread.
Pilonidal Cyst Surgery
Sometimes, surgery is needed to remove the cyst entirely.
After surgery, your doctor may leave the wound that results from the surgery open, packing it with dressing so it can stay dry.
This approach has a longer healing time, but experts say the chance of an infection returning are lower than closing the wound with stitches.
If the wound has been packed with a dressing, be sure to ask how to change the dressing before you leave for home.
Ask, too, about normal healing time and anything you should watch out for once at home.
In some cases, skin grafts are needed.
Researchers are evaluating non-surgical ways to treat pilonidal disease.
For instance, some are using intensed pulsed light to remove hairs from the area and reduce the chances of cysts returning.
Pilonidal Cyst Home Treatment
Good hygiene can help keep infection at bay. Other measures that may help prevent infection from returning:
- Shave around the cyst area, if your doctor approves, to keep hairs from becoming embedded.
- Clean the area with mild soap and water. Rinse well to get rid of soap residue.
- If you need to sit for long periods, take frequent breaks.
- Avoid wearing tight clothing, as hair can be forced down into the skin.
- Soak in a warm bathtub of water for pain relief.
What is pilonidal disease?
Pilonidal disease is a chronic skin problem found most often in the sacrococcygeal region. This is the cleft between the buttocks just below the base of the spine. It is characterised by one or more sinus tracts; these are cavities with a narrow opening on the skin surface (pilonidal sinus). In most cases, the cavity is filled with nests of hair – hence the name pilonidal (“pilus” meaning hair and “nidal” meaning nest). A non-inflamed lump is known as a pilonidal cyst. If the sinus becomes infected a pilonidal abscess may form.
What causes pilonidal disease?
The exact reason why pilonidal disease occurs is still unclear. Possible causes include:
- Some people are born with small holes or pits near the base of the spine. These are in fact enlarged hair follicles.
- Follicular occlusion; some people are genetically prone to this. They may also suffer from hidradenitis suppurativa, acne conglobata and dissecting cellulitis (follicular occlusion syndrome or tetrad).
- When subjected to friction and motion, the follicles are injured and disrupted so the hair pokes through the wall of the follicle into the surrounding skin setting up a foreign body reaction.
- Neighbouring hairs or free hairs from other parts of the body collect in the pit and invade the small opening created by the distorted hair follicles.
- Skin and perineal bacteria such as Staphylococcus aureus and Bacteroides species invade the opening and cause infection.
Who gets pilonidal disease?
Pilonidal disease affects both men and women usually between the ages of 20–40 years. It is 2–3 times more common in men than women. Other factors that increase the risk of pilonidal disease include:
- Coarse, curly or crinkly hair
- Family predisposition
- Poor hygiene
- Prolonged sitting or buttock friction causing increased sweating
- Repeated local injury (once known as “Jeep rider’s disease” as it hospitalised more than 80,000 US soldiers in WWII)
- Co-existing hidradenitis suppurativa
What are the signs and symptoms?
Signs and symptoms can vary from a small painless pit or dimple at the base of the spine to a large painful abscess. Most patients have progressive tenderness, particularly after prolonged periods of sitting, such as during a long drive. Signs and symptoms include:
- Pain, redness and swelling
- Small hole or holes draining fluid that may be clear, cloudy or bloody
- If infected, the draining pus may have a foul odour
- Fever, malaise or nausea
- Visible or lumpy tracts 2–5 cm long in chronic or recurrent pilonidal disease
How is the diagnosis made?
The clinical features of pilonidal sinus is usually straightforward. If necessary, skin biopsy can be undertaken. The histopathological features of pilonidal sinus characteristically show foreign body reaction.
What treatment is available?
A pilonidal cyst that isn’t causing any problems doesn’t require any treatment. The patient should be advised to keep the area clean and free of hair by shaving or using a hair removal agent every 2–3 weeks. The cyst may resolve itself. Persistent and inflamed cysts (acute pilonidal abscess) are incised (cut into) and drained out to reduce inflammation and pain. Occasionally the abscess cavity may be cut out completely to remove hair nests and skin debris; this reduces the rate of recurrence to about 15%.
Persistent, complex or recurrent pilonidal sinus disease must be treated surgically. Procedures vary from taking the roof off the sinuses to wide and deep excision (ie all affected areas are completely cut out). In all cases, the cavity is scrubbed and scraped out to remove hair and abnormally healing granulation tissue. Several techniques are available for wound healing and closure; these include
- Dressing or packing open wounds
- Marsupialisation (forming a pouch), which results in a smaller wound compared to wounds that are left open to granulate
- Closure using skin flaps for wide excisions.
Have you ever developed a small cyst in the crease of your buttocks or tailbone? It may have been a small dimple, or could have started that way and developed into a large and painful mass. This condition is caused by pilonidal disease and there are more than 70,000 cases diagnosed in the US each year.
About Pilonidal Disease
Pilonidal disease is a chronic skin infection in the crease of the buttocks near the coccyx (tailbone). Pilonidal disease can be a one-time cyst or be a chronic condition.
Who Gets Pilonidal Disease?
Anyone can be impacted by pilonidal disease. This condition is more common in men than women and often occurs between puberty and age 40 with the average age being between 20 and 35. Obesity and thick, stiff body hair can make people more prone to pilonidal disease. Pilonidal disease is more common in people who sit often, and wearing tight clothing can make the condition worse. If chronic pilonidal disease is not treated it can lead to abscesses and sinus cavities.
Causes of Pilonidal Disease
Hairs often grow in the “cleft” between the buttocks. These hair follicles can become infected. If not treated, the hair can be drawn into these abscesses creating a “pit”, inflammation and making the problem worse.
Pilonidal Disease Symptoms
Symptoms of pilonidal disease can vary from mild to severe depending on the severity of the cyst. Symptoms may include:
- Small dimple
- Large painful mass
- Clear, cloudy or bloody drainage from the area
- If infected, the area can become red or tender and also foul smelling drainage (pus)
- If infected, you may develop a fever, nausea or feel sick
Treatments for Pilonidal Cysts
To get the right treatment plan, you need to have a physician examine your cyst. Treatment will depend on the disease pattern. The primary treatment for a small abscess is to drain the cyst through an incision. If more severe you may require surgical treatment from a colorectal surgeon. Your colorectal surgeon will examine your cyst and determine if an excision or “cleft lift” procedure is best for you.
- Cleft Lift
- In this procedure, your surgeon will reshape the cleft to be shallower and remove infected areas which allows for better healing. The wound/incision is done away from the midline to decrease the time it takes to heal. This procedure is performed as an outpatient procedure while you are under anesthesia. Recovery takes about 2 weeks and doesn’t require and special packing or wound dressing.
- Excision with Primary Closure
- Tissue around the cyst and sinuses are removed and the wound area is closed with stitches. This procedure is performed as an outpatient procedure while you are under anesthesia. Recovery takes about 4 weeks. This method is faster healing than the open procedure, but has a higher infection rate. Those that have this type of procedure need to be careful not to pop stiches since this area of the body moves in many directions during your daily routine which can place additional stress on stiches.
- Excision with Open Healing
- Tissue around the cyst and sinuses are completely removed. This results in a wound that is open to heal and fill in from the bottom. Your wound will need to be cleaned out and re-packed with gauze at least two times a day. This procedure is performed as an outpatient procedure while you are under anesthesia. Recovery takes about 8 weeks. This is the slowest healing, but has a lower rate of infection compared to a closed wound.