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

Understanding Pilonidal Cysts: A Common but Often Misunderstood Condition

Pilonidal cysts are fluid-filled sacs that develop under the skin, typically in the lower back area near the crease of the buttocks. These cysts can range from being barely noticeable to causing significant discomfort, especially when infected. To better understand this condition, it’s essential to explore its nature, causes, and potential complications.

What Exactly is a Pilonidal Cyst?

A pilonidal cyst is a sac filled with fluid that forms beneath the skin, usually near the tailbone. While some may not be visible, others can appear as small pits or dimples in the skin. These cysts generally don’t cause issues unless they become infected, at which point they are referred to as pilonidal abscesses.

The Formation Process of Pilonidal Cysts

How do pilonidal cysts develop? Medical professionals believe that these cysts form when loose hair and dead skin cells become trapped under the skin. The process typically unfolds as follows:

1. Skin in the tailbone area stretches during sitting or bending.
2. This stretching can cause hairs to break off.
3. Movement pushes the broken hairs and dead skin cells under the skin.
4. The body’s immune system treats these as foreign objects.
5. A cyst forms around the hair and dead skin cells, filling with fluid.

Recognizing the Signs and Symptoms of Pilonidal Cysts

Identifying a pilonidal cyst early can lead to more effective treatment and prevent complications. While an uninfected cyst might not cause any noticeable symptoms, an infected pilonidal abscess can present with several distinct signs.

Symptoms of an Infected Pilonidal Cyst

What are the telltale signs of an infected pilonidal cyst? An individual with an infected cyst may experience:

• Pain, redness, and swelling in the affected area
• Pus or blood draining from a small opening (sinus tract) in the skin over or near the cyst
• Fever

It’s crucial to seek medical attention if you notice these symptoms, as prompt treatment can prevent the infection from worsening or spreading.

Risk Factors: Who is Most Likely to Develop Pilonidal Cysts?

While pilonidal cysts can affect anyone, certain factors may increase an individual’s likelihood of developing this condition. Understanding these risk factors can help in prevention and early detection.

Common Risk Factors for Pilonidal Cysts

Who is more susceptible to developing pilonidal cysts? The following factors may increase the risk:

• Gender and Age: Young men are more commonly affected
• Anatomy: Being born with a dimple or pit in the tailbone area
• Lifestyle: Spending long periods in a sitting position
• Body Composition: Being overweight or obese
• Hair Characteristics: Having abundant body hair, especially if it’s thick or coarse
• Clothing Choices: Wearing tight clothing that puts pressure on the tailbone area
• Genetics: Having family members with a history of pilonidal cysts

Understanding these risk factors can help individuals take preventive measures and seek early medical attention if they suspect they may be developing a pilonidal cyst.

Diagnosing Pilonidal Cysts: What to Expect

The process of diagnosing a pilonidal cyst is typically straightforward, relying primarily on physical examination and patient history. Understanding this process can help alleviate anxiety for those seeking medical attention for a suspected pilonidal cyst.

The Diagnostic Process

How do healthcare providers diagnose pilonidal cysts? The diagnostic process usually involves:

1. Physical Examination: The doctor will inspect the affected area, looking for characteristic signs of a pilonidal cyst.
2. Location Assessment: The position of the cyst, typically near the tailbone, is a key diagnostic factor.
3. Evaluation of Appearance and Texture: The doctor will assess how the cyst looks and feels.
4. Patient History: Information about symptoms, duration, and any previous occurrences can aid in diagnosis.

In most cases, additional tests are not necessary for diagnosing pilonidal cysts. However, if there are concerns about other potential conditions, further investigations may be recommended.

Treatment Options for Pilonidal Cysts: From Home Care to Surgery

The treatment approach for pilonidal cysts depends on the severity of the condition and whether the cyst is infected. Options range from simple home care methods to more invasive surgical procedures.

Non-Surgical Treatment Options

For mild cases or uninfected cysts, conservative treatments may be sufficient:

• Observation: Asymptomatic cysts may not require treatment.
• Sitz Baths: Soaking the affected area in warm water can help relieve discomfort.
• Warm Compresses: Applying heat can promote drainage and reduce inflammation.
• Hair Removal: Keeping the area free of hair can prevent recurrence.

Surgical Interventions for Infected Cysts

When home care is ineffective or the infection is severe, surgical options may be necessary:

• Incision and Drainage: A small cut is made to drain the abscess.
• Gips Procedure: A minimally invasive technique to drain the abscess.
• Antibiotics: May be prescribed if the infection spreads to surrounding skin.

In recurring cases, more extensive surgery to remove the cyst entirely may be recommended.

Post-Treatment Care and Prevention Strategies

Proper care after treatment and preventive measures are crucial in managing pilonidal cysts and reducing the risk of recurrence. Following healthcare provider instructions and maintaining good hygiene practices are key components of effective post-treatment care.

Post-Treatment Home Care

How should one care for a pilonidal cyst after treatment? Follow these guidelines:

• Clean the area as directed by your healthcare provider.
• Remove hair from the area regularly if advised.
• Avoid prolonged sitting periods.
• Sleep on your side or stomach to reduce pressure on the affected area.
• Take prescribed antibiotics as directed if they were prescribed.
• Change or remove bandages as recommended.
• Avoid bathing or swimming until cleared by your doctor.

Preventing Recurrence

Can pilonidal cysts be prevented from coming back? While recurrence is possible, these strategies may help reduce the risk:

• Maintain good hygiene in the affected area.
• Consider permanent hair removal methods like laser treatment.
• Maintain a healthy weight to reduce pressure on the tailbone area.
• Wear loose-fitting clothing to minimize friction and pressure.
• Stay active and avoid prolonged periods of sitting.

Living with Pilonidal Cysts: Long-Term Management and Quality of Life

For some individuals, pilonidal cysts can be a recurring issue that requires ongoing management. Understanding how to live with this condition and maintain a good quality of life is essential for those affected.

Coping with Recurring Pilonidal Cysts

How can one manage recurring pilonidal cysts effectively? Consider these strategies:

• Regular Check-ups: Schedule routine visits with your healthcare provider to monitor the condition.
• Lifestyle Modifications: Implement changes in daily habits to reduce risk factors.
• Stress Management: Chronic conditions can be stressful; consider stress-reduction techniques.
• Support Groups: Connecting with others who have similar experiences can provide emotional support.

Impact on Daily Life

Living with pilonidal cysts may require some adjustments to daily routines:

• Work Accommodations: Consider ergonomic seating options or standing desks.
• Exercise Modifications: Choose activities that don’t exacerbate the condition.
• Clothing Choices: Opt for loose, breathable fabrics to reduce irritation.
• Travel Preparations: Plan for comfort during long trips with appropriate seating aids.

By adopting these strategies and working closely with healthcare providers, individuals with pilonidal cysts can effectively manage their condition and maintain a high quality of life.

Advances in Pilonidal Cyst Treatment: Exploring New Techniques

As medical science progresses, new approaches to treating pilonidal cysts are emerging. These advancements aim to improve treatment outcomes, reduce recovery times, and lower recurrence rates.

Innovative Surgical Techniques

What are some of the latest surgical innovations for pilonidal cyst treatment? Consider these emerging approaches:

• Endoscopic Pilonidal Sinus Treatment (EPSiT): A minimally invasive technique using endoscopic equipment.
• Laser Treatment: Using laser technology to destroy the cyst and seal off sinus tracts.
• Fibrin Glue: A non-surgical method involving the injection of fibrin glue to close the sinus.
• Pit-picking Technique: A minimally invasive procedure for less severe cases.

Potential Future Treatments

Research continues to explore new avenues for pilonidal cyst treatment:

• Stem Cell Therapy: Investigating the use of stem cells to promote healing and prevent recurrence.
• Bioengineered Tissue: Developing specialized tissue grafts to repair affected areas.
• Targeted Drug Delivery: Exploring localized medication delivery systems for more effective treatment.

While these innovative approaches show promise, it’s important to note that they may not be widely available or suitable for all cases. Always consult with a healthcare professional to determine the most appropriate treatment option for your specific situation.

Pilonidal Cysts in Special Populations: Considerations and Approaches

While pilonidal cysts can affect anyone, certain populations may require special considerations in their diagnosis, treatment, and management. Understanding these unique aspects can lead to more effective care for diverse patient groups.

Pilonidal Cysts in Adolescents

How does the approach to pilonidal cysts differ for teenagers? Consider these factors:

• Growth and Development: Rapid physical changes may influence treatment decisions.
• Psychosocial Impact: Body image concerns may be more pronounced in this age group.
• Educational Disruption: Treatment and recovery may interfere with schooling.
• Long-term Planning: Focus on prevention strategies to reduce recurrence risk in adulthood.

Pregnancy and Pilonidal Cysts

Managing pilonidal cysts during pregnancy presents unique challenges:

• Treatment Limitations: Some surgical options may be contraindicated during pregnancy.
• Symptom Management: Focus on conservative treatments to alleviate discomfort.
• Postpartum Care: Planning for more definitive treatment after delivery if necessary.
• Breastfeeding Considerations: Ensuring treatment compatibility with breastfeeding plans.

Pilonidal Cysts in Older Adults

Elderly patients may require a tailored approach to pilonidal cyst management:

• Comorbidities: Considering other health conditions that may affect treatment options.
• Medication Interactions: Evaluating potential drug interactions with existing prescriptions.
• Mobility Issues: Adapting care plans for patients with limited mobility.
• Wound Healing: Accounting for potentially slower healing processes in older individuals.

By recognizing and addressing the unique needs of different patient populations, healthcare providers can offer more personalized and effective care for individuals with pilonidal cysts across all life stages.

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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Surgery for pilonidal cyst: MedlinePlus Medical Encyclopedia

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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

Hyman N, Umanskiy K. Anus. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 53.

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.

Updated by: Debra G. Wechter, MD, FACS, General Surgery Practice Specializing in Breast Cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Tailbone cyst (coccygeal passage), treatment at “VERBA MEDICAL” LLC

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Epithelial coccygeal passage (coccygeal cyst) is an acquired or congenital pathology in the sacrococcygeal region, caused by the formation of a cavity under the skin in the intergluteal fold in the form of a tunnel or channel lined from the inside with an epithelium that has the properties of ordinary skin (the presence of hair follicles, sebaceous and sweat glands). This cavity is located at a depth of 2-3 cm, is in no way connected with the coccyx and bones, it may have one or more exits to the skin surface.

This pathology most often develops as a result of impaired intrauterine development. Another reason for the formation of an epithelial coccygeal passage may be the abnormal growth of hair cutting into the skin. This pathology is also called the “jeep” disease, since it develops more often in men with dark skin, increased hairiness, overweight, with a deep intergluteal fold, leading a sedentary lifestyle (drivers, tractor drivers, office workers, etc.)
do not manifest itself for many years and the patient may not even know about its presence.

In the event that an infection gets into the openings of the cyst or an injury develops in the coccygeal passage, an inflammatory process develops. This leads to an increase in the size of the epithelial coccygeal passage and the destruction of its walls. Inflammation passes to the surrounding tissue.

Direct exacerbation and formation of a coccygeal fistula lead to:

• Sedentary work and excess weight
• Non-observance of hygiene rules
• Excessive hairline
• Excessive sweating
• Permanent injury
• Concomitant diseases (diabetes mellitus, dishormonal disorders)

Symptoms of the epithelial coccygeal passage

Exacerbation of the disease is manifested by such symptoms as:

• discomfort in the coccyx and lower back;
• swelling of the skin in the sacrococcygeal region;
• reddening of the skin in the projection of the cyst;
• acute or dull pain, bursting and hoarseness, depending on the severity of the disease in the projection of the coccyx while sitting or walking fast, running.

With prolonged or absent treatment, inflammation progresses, the cyst suppurates, an abscess develops. There is general intoxication, weakness, body temperature rises, headaches, nausea appear. A purulent discharge may be discharged from the fistulous opening.

The chronic form of the disease leads to serious complications:

• opening of the cyst membrane, infection around the lying tissues, development of phlegmon with further spread of its purulent contents into the small pelvis, bone structures of the coccyx and sacrum, soft tissues of the back, etc.;
• infection of the blood with the development of sepsis;
• and the most favorable outcome is the opening of a purulent abscess outwards in the form of a fistula.

Treatment of epithelial coccygeal tract

Epithelial coccygeal tract is a potential focus of inflammation with the formation of purulent infiltrates and fistulas. Conservative treatments can only give temporary results.