What is a pilonidal cyst. How does a pilonidal cyst 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. Can pilonidal cysts be prevented.

Understanding Pilonidal Cysts: Formation and Location

A pilonidal cyst is a fluid-filled sac that develops under the skin, typically located in the lower back near the crease of the buttocks. These cysts form when loose hair and dead skin cells become trapped beneath the skin’s surface. As a person moves or sits, the skin in the tailbone area stretches, causing hairs to break off and potentially get pushed under the skin along with dead skin cells. The body’s immune system responds by forming a cyst around these foreign materials, which then fills with fluid.

The appearance of pilonidal cysts can vary. Some may not be visible at all, while others might appear as a small pit or dimple in the skin. The term “pilonidal” comes from the Latin words “pilus” (hair) and “nidus” (nest), aptly describing the nature of these cysts.

Are pilonidal cysts always visible?

No, pilonidal cysts are not always visible. Some cysts may remain hidden beneath the skin’s surface, while others can manifest as small pits or dimples in the skin. The visibility of a pilonidal cyst often depends on its size and whether it has become infected.

Identifying Symptoms of Infected 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 and potentially severe symptoms. Recognizing these signs is crucial for prompt treatment and prevention of complications.

• Pain, redness, and swelling in the area of the cyst
• Pus or blood draining from a small opening (sinus tract) in the skin over or near the cyst
• Fever
• Difficulty sitting or lying on the back
• Foul odor from the affected area

Can pilonidal cysts resolve without treatment?

In some cases, uninfected pilonidal cysts may not require treatment and can resolve on their own. However, if a cyst becomes infected or causes persistent discomfort, medical intervention is necessary to prevent complications and alleviate symptoms.

Risk Factors for Developing Pilonidal Cysts

While pilonidal cysts can affect anyone, certain factors increase the likelihood of their development. Understanding these risk factors can help individuals take preventive measures and seek early treatment if necessary.

1. Gender and age: Young men are more commonly affected by pilonidal cysts.
2. Congenital factors: Being born with a dimple or pit in the tailbone area increases the risk.
3. Sedentary lifestyle: Spending long periods in a sitting position can contribute to cyst formation.
4. Body weight: Overweight individuals are more susceptible to developing pilonidal cysts.
5. Body hair: Having a lot of body hair, especially if it’s thick or coarse, increases the risk.
6. Clothing choices: Wearing tight clothing that puts pressure on the tailbone area may contribute to cyst development.
7. Genetic predisposition: Having family members with a history of pilonidal cysts may increase one’s risk.

Does obesity increase the risk of pilonidal cysts?

Yes, being overweight or obese can increase the risk of developing pilonidal cysts. Excess weight can create deeper skin folds in the buttocks area, providing more opportunities for hair and dead skin cells to become trapped and form cysts.

Diagnostic Approaches for Pilonidal Cysts

Diagnosing a pilonidal cyst is typically straightforward and does not require extensive testing. Healthcare providers usually rely on a combination of physical examination and patient history to make an accurate diagnosis.

During the examination, the doctor will assess the location, appearance, and any symptoms associated with the cyst. They may gently palpate the area to check for tenderness or drainage. In most cases, the characteristic location and appearance of the cyst are sufficient for diagnosis.

In some instances, if there is uncertainty or suspicion of other conditions, additional diagnostic tests may be ordered. These could include:

• Ultrasound imaging to visualize the cyst and surrounding tissues
• MRI scan for a more detailed view of the affected area
• Blood tests to check for signs of infection or inflammation

Is a biopsy necessary to diagnose a pilonidal cyst?

In most cases, a biopsy is not necessary to diagnose a pilonidal cyst. The characteristic location and appearance of the cyst, along with the patient’s symptoms and medical history, are usually sufficient for an accurate diagnosis. However, in rare cases where there is suspicion of a more serious condition, a biopsy may be performed to rule out other possibilities.

Treatment Options for Pilonidal Cysts

The treatment approach for pilonidal cysts depends on the severity of the condition and whether the cyst is infected. Treatment options range from conservative home care to surgical interventions.

Conservative Treatment

For mild cases or uninfected cysts, conservative treatment may be sufficient. This can include:

• Sitz baths: Soaking the affected area in warm water to promote healing and reduce discomfort
• Warm compresses: Applying warm, moist cloths to the area to help draw out any infection
• Keeping the area clean and dry
• Hair removal in the affected area to prevent further irritation

Gips Procedure

For infected cysts that don’t respond to conservative treatment, the Gips procedure may be recommended. This minimally invasive technique involves:

1. Making a small incision to drain the abscess
2. Cleaning the wound
3. Leaving the wound open to heal from the inside out

Surgical Intervention

In cases of recurrent or severe pilonidal cysts, surgery may be necessary. Surgical options include:

• Incision and drainage: A simple procedure to drain an infected cyst
• Excision: Removal of the entire cyst and surrounding tissue
• Marsupialization: Creating a pouch from the cyst to allow for drainage and healing
• Flap procedures: Using nearby tissue to close the wound after cyst removal

Is antibiotic treatment effective for pilonidal cysts?

Antibiotics alone are generally not effective in treating pilonidal cysts, especially if they are infected. While antibiotics may be prescribed to control the spread of infection to surrounding tissues, they do not address the underlying cause of the cyst. Drainage or surgical intervention is typically necessary for proper treatment of infected pilonidal cysts.

Post-Treatment Care and Prevention

Proper care after treatment is crucial for promoting healing and preventing recurrence of pilonidal cysts. Following your healthcare provider’s instructions is essential for a successful recovery.

Post-Treatment Care

• Keep the area clean and dry
• Change dressings as directed by your healthcare provider
• Avoid sitting for prolonged periods
• Sleep on your side or stomach to reduce pressure on the affected area
• Take prescribed medications, including antibiotics, as directed
• Attend follow-up appointments to monitor healing progress

Prevention Strategies

While it’s not always possible to prevent pilonidal cysts, certain measures can reduce the risk of their formation or recurrence:

1. Maintain good hygiene in the tailbone area
2. Regularly remove hair from the area through shaving or hair removal products
3. Consider permanent hair removal methods, such as laser hair removal
4. Avoid prolonged sitting and take frequent breaks to stand or walk
5. Maintain a healthy weight to reduce pressure on the tailbone area
6. Wear loose-fitting clothing to minimize friction and pressure on the affected area
7. Stay physically active to improve circulation and reduce the risk of cyst formation

Can laser hair removal prevent pilonidal cysts?

Laser hair removal can be an effective method for preventing pilonidal cysts, especially in individuals prone to recurrent cysts. By permanently reducing hair growth in the tailbone area, laser hair removal minimizes the risk of hair becoming trapped under the skin and forming cysts. However, it’s important to consult with a healthcare provider before undergoing any hair removal procedures to ensure it’s appropriate for your specific situation.

Long-Term Outlook and Potential Complications

The long-term outlook for individuals with pilonidal cysts varies depending on the severity of the condition and the effectiveness of treatment. While many people experience successful resolution of their cysts with proper treatment, recurrence is a common concern.

Recurrence Rates

Pilonidal cysts have a tendency to recur, even after successful treatment. Recurrence rates can vary widely, with some studies reporting rates between 20% and 40%. Factors that may influence recurrence include:

• The type of treatment received
• The extent of the initial cyst or infection
• Individual risk factors, such as body hair and lifestyle habits
• Adherence to post-treatment care and prevention strategies

Potential Complications

If left untreated or improperly managed, pilonidal cysts can lead to several complications:

1. Chronic infection: Recurring infections can lead to the formation of multiple sinus tracts
2. Abscess formation: Severe infections can result in larger, more painful abscesses
3. Cellulitis: Infection can spread to surrounding tissues, causing widespread inflammation
4. Sepsis: In rare cases, severe infections can lead to a life-threatening systemic infection
5. Squamous cell carcinoma: Very rarely, chronic pilonidal disease can lead to the development of skin cancer in the affected area

Can pilonidal cysts lead to serious health problems?

While most pilonidal cysts can be successfully treated without long-term consequences, untreated or chronically infected cysts can potentially lead to serious health problems. These may include extensive tissue damage, systemic infections, and in extremely rare cases, the development of skin cancer. Prompt treatment and proper management are crucial to prevent such complications and maintain overall health.

Emotional and Psychological Impact of Pilonidal Cysts

The physical discomfort of pilonidal cysts is often accompanied by emotional and psychological challenges. Understanding and addressing these aspects of the condition is crucial for comprehensive patient care.

Common Emotional Responses

• Embarrassment: Due to the location of the cysts and potential odor or drainage
• Anxiety: Fear of recurrence or need for surgical intervention
• Depression: Chronic pain and lifestyle limitations can affect mood
• Body image issues: Scarring or persistent symptoms may impact self-esteem
• Social isolation: Discomfort may lead to avoiding social activities

Coping Strategies

Developing effective coping mechanisms can significantly improve the quality of life for individuals dealing with pilonidal cysts:

1. Seek support: Connect with friends, family, or support groups for emotional backing
2. Education: Learn about the condition to feel more in control of your health
3. Stress management: Practice relaxation techniques to reduce stress-related flare-ups
4. Open communication: Discuss concerns with healthcare providers to address all aspects of care
5. Focus on overall health: Maintain a healthy lifestyle to support both physical and mental well-being

How can patients cope with the psychological impact of pilonidal cysts?

Coping with the psychological impact of pilonidal cysts involves a multifaceted approach. Patients can benefit from seeking professional counseling to address anxiety or depression, joining support groups to connect with others facing similar challenges, and practicing self-care techniques such as mindfulness and stress reduction. Additionally, maintaining open communication with healthcare providers about both physical and emotional concerns can lead to more comprehensive and effective treatment strategies.

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.