What is a pilonidal cyst. How does a pilonidal cyst form. What are the symptoms of an infected pilonidal cyst. Who is at risk of developing pilonidal cysts. How are pilonidal cysts diagnosed and treated. What can be done to prevent pilonidal cysts from recurring.

Understanding Pilonidal Cysts: A Comprehensive Overview

A pilonidal cyst is a fluid-filled sac that develops under the skin, typically near the tailbone or in the crease between the buttocks. These cysts can range from being barely noticeable to causing significant discomfort, especially when infected. To better understand this condition, let’s explore its nature, causes, and implications.

What exactly is a pilonidal cyst?

A pilonidal cyst is a pocket that forms around hair follicles in the natal cleft – the area between the buttocks. While some cysts remain undetectable, others may appear as small pits or dimples in the skin. The term “pilonidal” comes from Latin, meaning “nest of hair,” which aptly describes the contents often found within these cysts.

How do pilonidal cysts form?

The formation of pilonidal cysts is believed to be a result of loose hair and dead skin cells becoming trapped beneath the skin’s surface. As we sit or bend, the skin in the tailbone area stretches, potentially causing hairs to break off. Movement can then push these broken hairs and dead skin cells under the skin. The body’s immune system recognizes these as foreign objects and forms a cyst around them, which fills with fluid.

Recognizing the Symptoms of Pilonidal Cysts

While an uninfected pilonidal cyst may not cause any noticeable symptoms, an infected cyst (also known as a pilonidal abscess) can lead to several uncomfortable signs. Identifying these symptoms early can help in seeking timely treatment.

What are the telltale signs of an infected pilonidal cyst?

An infected pilonidal cyst may present with the following symptoms:

• Pain, redness, and swelling in the affected area
• Drainage of pus or blood from a small opening (sinus tract) in the skin over or near the cyst
• Fever
• Discomfort when sitting or during movement

If you experience any of these symptoms, it’s crucial to consult a healthcare professional for proper diagnosis and treatment.

Risk Factors and Predisposition to Pilonidal Cysts

While pilonidal cysts can affect anyone, certain factors may increase the likelihood of developing this condition. Understanding these risk factors can help in taking preventive measures.

Who is more susceptible to developing pilonidal cysts?

Pilonidal cysts are most commonly observed in young men, but several factors can increase the risk of development:

• Being born with a dimple or pit in the tailbone area
• Spending prolonged periods in a sitting position
• Being overweight or obese
• Having excessive body hair, especially if it’s thick or coarse
• Wearing tight clothing that puts pressure on the tailbone area
• Having a family history of pilonidal cysts

Understanding these risk factors can help individuals take proactive steps to reduce their chances of developing pilonidal cysts.

Diagnosis and Treatment Options for Pilonidal Cysts

Proper diagnosis and timely treatment of pilonidal cysts are essential for managing the condition effectively and preventing complications. Let’s explore the diagnostic process and various treatment options available.

How are pilonidal cysts diagnosed?

Doctors typically diagnose pilonidal cysts based on their location and physical appearance. A thorough examination of the affected area is usually sufficient for an accurate diagnosis. In some cases, additional tests may be required to rule out other conditions or assess the extent of the infection.

What treatment options are available for pilonidal cysts?

The treatment for pilonidal cysts depends on the severity of the condition and whether the cyst is infected. Here are some common approaches:

1. Conservative management: Asymptomatic cysts may not require treatment.
2. Home care: Mild infections can be treated with sitz baths and warm compresses.
3. Gips procedure: For more severe infections, doctors may perform a minor procedure to drain the abscess.
4. Antibiotics: If the infection spreads to surrounding skin, antibiotics may be prescribed.
5. Surgery: In recurring cases or severe infections, surgical removal of the cyst may be recommended.

The choice of treatment depends on individual circumstances and should be discussed with a healthcare provider.

Managing Pilonidal Cysts at Home

While medical intervention is often necessary for infected pilonidal cysts, there are several steps you can take at home to manage the condition and promote healing.

What are effective home care strategies for pilonidal cysts?

To care for a pilonidal cyst at home, consider the following measures:

• Clean the affected area as directed by your healthcare provider
• Remove hair from the area regularly, if recommended by your doctor
• Avoid sitting for extended periods
• Sleep on your side or stomach to reduce pressure on the affected area
• Follow post-drainage care instructions carefully if you’ve had the cyst drained
• Take prescribed antibiotics as directed, if applicable
• Change or remove bandages as recommended by your healthcare provider

Consistent home care can significantly contribute to the healing process and help prevent recurrence.

Surgical Interventions for Pilonidal Cysts

In some cases, especially with recurrent or severe infections, surgical intervention may be necessary to effectively treat pilonidal cysts. Understanding the surgical options can help patients make informed decisions about their treatment.

What surgical procedures are used to treat pilonidal cysts?

Several surgical approaches are available for treating pilonidal cysts:

1. Incision and drainage: This is the most common procedure for infected cysts. It involves making a small cut to drain the fluid and pus.
2. Excision: In this procedure, the entire cyst and surrounding tissue are removed.
3. Marsupialization: After removing the cyst, the wound is left open to heal from the inside out.
4. Flap procedures: These involve using nearby skin to cover the wound after cyst removal, promoting faster healing.

The choice of surgical procedure depends on factors such as the size and location of the cyst, the severity of the infection, and the patient’s overall health.

Prevention and Long-term Management of Pilonidal Cysts

While pilonidal cysts can be challenging to prevent entirely, there are strategies to reduce the risk of development and recurrence. Long-term management is crucial for individuals prone to this condition.

How can one prevent pilonidal cysts from recurring?

To minimize the risk of pilonidal cyst recurrence, consider the following preventive measures:

• Maintain good hygiene in the affected area
• Keep the area free of hair through regular shaving or permanent hair removal methods
• Avoid prolonged periods of sitting
• Maintain a healthy weight
• Wear loose-fitting clothing to reduce pressure on the tailbone area
• Exercise regularly to improve circulation and overall health

Implementing these strategies can significantly reduce the likelihood of pilonidal cysts recurring and improve overall quality of life.

Living with Pilonidal Cysts: Lifestyle Adjustments and Considerations

Dealing with pilonidal cysts often requires making certain lifestyle adjustments to manage the condition effectively and prevent complications. Understanding these considerations can help individuals lead comfortable and healthy lives despite the challenges posed by pilonidal cysts.

What lifestyle changes can help in managing pilonidal cysts?

Consider implementing the following lifestyle adjustments:

• Develop a regular exercise routine to maintain a healthy weight and improve circulation
• Use cushions or specialized seating devices to reduce pressure on the tailbone area when sitting for extended periods
• Opt for loose-fitting, breathable clothing to minimize friction and moisture in the affected area
• Incorporate stress-reduction techniques, as stress can sometimes exacerbate symptoms
• Stay informed about new treatments and management strategies for pilonidal cysts

By making these adjustments, individuals with pilonidal cysts can significantly improve their quality of life and reduce the impact of the condition on their daily activities.

How does living with pilonidal cysts affect daily life?

Living with pilonidal cysts can present various challenges in daily life:

1. Discomfort during certain activities, particularly those involving sitting or movement
2. Potential embarrassment due to symptoms or visible signs of the condition
3. Need for regular medical check-ups and treatments
4. Possible limitations in clothing choices or recreational activities
5. Emotional impact, including stress or anxiety related to the condition

Despite these challenges, with proper management and support, many individuals with pilonidal cysts lead fulfilling and active lives. It’s important to communicate openly with healthcare providers and loved ones about the condition to ensure appropriate care and understanding.

Emerging Treatments and Future Prospects for Pilonidal Cyst Management

As medical research advances, new treatments and management strategies for pilonidal cysts continue to emerge. Staying informed about these developments can provide hope and additional options for those affected by this condition.

What are some promising new treatments for pilonidal cysts?

Several innovative approaches are being explored for the treatment of pilonidal cysts:

• Laser therapy: Using targeted laser treatments to remove hair and reduce the risk of cyst formation
• Endoscopic techniques: Minimally invasive procedures that may offer faster recovery times
• Regenerative medicine: Exploring the use of stem cells or growth factors to promote healing
• Advanced wound care: Implementing new dressing technologies to enhance healing after drainage or surgery
• Immunomodulatory therapies: Investigating treatments that can modify the immune response to prevent cyst formation

While many of these treatments are still in the research phase, they offer promising avenues for improving the management of pilonidal cysts in the future.

How might future research impact the treatment of pilonidal cysts?

Ongoing research into pilonidal cysts could lead to several advancements:

1. Better understanding of the genetic factors contributing to cyst formation
2. Development of more effective preventive strategies
3. Creation of targeted therapies with fewer side effects
4. Improvement in surgical techniques to reduce recurrence rates
5. Enhanced diagnostic tools for early detection and intervention

As research progresses, individuals affected by pilonidal cysts can look forward to potentially more effective and less invasive treatment options in the coming years.

In conclusion, while pilonidal cysts can be a challenging condition to manage, a combination of medical interventions, lifestyle adjustments, and staying informed about new developments can significantly improve outcomes. By working closely with healthcare providers and implementing appropriate management strategies, individuals with pilonidal cysts can maintain a high quality of life and effectively manage their condition.

Pilonidal Cyst (for Parents) – Nemours KidsHealth

en español: Quiste pilonidal

Reviewed by: Elana Pearl Ben-Joseph, MD

Primary Care Pediatrics at Nemours Children’s Health

What Is a Pilonidal Cyst?

A pilonidal cyst is a fluid-filled sac under the skin in the lower back, near the crease of the buttocks. Some aren’t visible, while others can look like a small pit or dimple in the skin.

They don’t usually cause problems or need treatment unless they get infected. A pilonidal (pie-luh-NIE-dul) cyst that’s infected is called a pilonidal abscess.

What Are the Signs & Symptoms of a Pilonidal Cyst?

A cyst that isn’t infected might not cause any symptoms. Someone with an infected cyst can have:

• pain, redness, and swelling in the area of the cyst
• pus or blood draining from a small opening (called a sinus tract) in the skin over or near the cyst
• a fever

What Causes a Pilonidal Cyst?

Doctors think that pilonidal cysts form when loose hair and dead skin cells get trapped under the skin. When we sit or bend, skin in the tailbone area stretches. This can cause hairs to break off. As a person moves, the broken hairs and dead skin cells can get pushed under the skin. The immune system treats the hair and dead skin cells as foreign, and forms a cyst around them that fills with fluid.

Who Gets Pilonidal Cysts?

Anyone can get a pilonidal cyst, but they’re most common in young men.

A person can be more likely to develop a pilonidal cyst if they:

• are born with a dimple or pit in their tailbone area
• spend a lot of time in a sitting position
• are overweight
• have a lot of body hair, especially if it’s thick or coarse
• wear tight clothing that presses on the tailbone area
• have family members with a pilonidal cyst

How Is a Pilonidal Cyst Diagnosed?

Doctors usually diagnose a pilonidal cyst based on where it is and how it looks and feels.

How Is a Pilonidal Cyst Treated?

A cyst that doesn’t cause symptoms might not need treatment.

Treatment for a pilonidal abscess depends on how severe the infection is. Home care with sitz baths and warm compresses can treat mild infections. If home care doesn’t work or the infection is more serious, doctors might make do the Gips procedure. This involves making a small cut to drain the abscess. They might prescribe antibiotics if the infection spreads to skin around the cyst.

How Can Parents Help?

To care for a pilonidal cyst at home:

• Clean the area as directed.
• If the doctor tells you to, regularly remove hair from the area by shaving or using a hair removal product. Permanent hair removal, such as laser hair removal, also might be an option.
• Remind your child to avoid sitting for long periods of time.
• Suggest that your child sleep on their side or stomach, which can be more comfortable.

If your child had a pilonidal cyst drained:

• If the doctor prescribed antibiotics, give them as directed.
• Change or remove the bandage as recommended.
• Your child shouldn’t take a bath or swim until the doctor says it’s OK.

What Else Should I Know?

After the infection heals, the doctor may suggest surgery to remove the cyst. Even after surgery, pilonidal cysts sometimes come back. Keeping the area clean and free of hair can help prevent an infection and new cysts.

Reviewed by: Elana Pearl Ben-Joseph, MD

Date reviewed: January 2020

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A pilonidal cyst is a pocket that forms around a hair follicle in the crease between the buttocks. The area may look like a small pit or pore in the skin that contains a dark spot or hair. Sometimes the cyst can become infected, and this is called a pilonidal abscess.

An infected pilonidal cyst or abscess requires surgical drainage. It will not heal with antibiotic medicines. If you continue to have infections, the pilonidal cyst can be removed by surgery.

There are several types of surgery.

Incision and drainage — This is the most common treatment for an infected cyst. It is a simple procedure done in the health care provider’s office.

• Local anesthesia is used to numb the skin.
• A cut is made in the cyst to drain fluid and pus. The hole is packed with gauze and left open.
• Afterward, it can take up to 4 weeks for the cyst to heal. The gauze has to be changed often during this time.

Pilonidal cystectomy — If you keep having problems with a pilonidal cyst, it can be removed surgically. This procedure is done as an outpatient procedure, so you will not need to spend the night in the hospital.

• You may be given medicine (general anesthesia) that keeps you asleep and pain-free. Or, you may be given medicine (regional anesthesia) that numbs you from the waist down. In rare cases, you may only be given local numbing medicine.
• A cut is made to remove the skin with the pores and the underlying tissue with the hair follicles.
• Depending on how much tissue is removed, the area may or may not be packed with gauze. Sometimes a tube is placed to drain fluid that collects after surgery. The tube is removed at a later time when the fluid stops draining.

It may be hard to remove the entire cyst, so there is a chance that it will come back.

Surgery is needed to drain and remove a pilonidal cyst that does not heal.

• Your provider may recommend this procedure if you have pilonidal disease that is causing pain or infection.
• A pilonidal cyst that is not causing symptoms does not need treatment.

Non-surgical treatment may be used if the area is not infected:

• Shaving or laser removal of hair around the cyst
• Injection of surgical glue into the cyst

Pilonidal cyst resection is generally safe. Ask your provider about these complications:

• Bleeding
• Infection
• Taking a long time for the area to heal
• Having the pilonidal cyst come back

Meet with your provider to make sure medical problems, such as diabetes, high blood pressure, and heart or lung problems are in good control.

Tell your provider:

• What medicines, vitamins, and other supplements you are taking, even ones you bought without a prescription.
• If you are or could be pregnant.
• If you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
• If you are a smoker, stop smoking several weeks before the surgery. Your provider can help.
• You may be asked to temporarily stop taking blood thinners, such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and any other medicines like these.
• Ask your provider which medicines you should take on the day of your surgery.

On the day of the surgery:

• Follow instructions about whether you need to stop eating or drinking before surgery.
• Take the medicines your provider told you to take with a small sip of water.
• Follow instructions on when to arrive at the hospital. Be sure to arrive on time.

After the procedure:

• You can go home after the procedure.
• The wound will be covered with a bandage.
• You will get pain medicines.
• It is very important to keep the area around the wound clean.
• Your provider will show you how to care for your wound.
• After it heals, shaving the hair in the wound area may help prevent pilonidal disease from coming back.

Pilonidal cysts come back in about one half of the people who have surgery the first time. Even after a second surgery, it may come back.

Pilonidal abscess; Pilonidal dimple; Pilonidal disease; Pilonidal cyst; Pilonidal sinus

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Johnson EK, Vogel JD, Cowan ML, et al. The American Society of Colon and Rectal Surgeons’ clinical practice guidelines for the management of pilonidal disease. Dis Colon Rectum. 2019;62(2):146-157. PMID: 30640830 pubmed.ncbi.nlm.nih.gov/30640830/.

Wells K, Pendola M. Pilonidal disease and perianal hidradenitis. In: Yeo CJ, ed. Shackelford’s Surgery of the Alimentary Tract. 8th ed. Philadelphia, PA: Elsevier Saunders; 2019:chap 153.