Pilonidal cysts usually occur when hair punctures the skin and then becomes embedded. If a pilonidal cyst becomes infected, it can be very painful. The cyst can be drained through a small cut in the skin. Sometimes, surgery is needed.
Some people have pilonidal cysts that become infected again and again over a long time. Without treatment, these people may be at increased risk of a type of skin cancer called squamous cell carcinoma.
In some cases, a pilonidal cyst can be hereditary (you can inherit it from a family member). Your family history can play a role in determining if you get pilonidal cysts, for example if rough body hair runs in your family.
Pilonidal cysts can sometimes be cured with surgery and your skin might heal fully. However, even after surgery, a pilonidal cyst can remain as a chronic, returning condition. This is true especially if the condition has gotten worse or if pilonidal cysts run in your family.
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A pilonidal cyst (pahy-luh-nayd-l sist) is a cavity or hole in the skin at the top part of your buttocks where the cheeks come together, at the cleft / crack. You may see lots of coarse hair stuck into the skin at this hole.
Most people ignore the first signs of an infected cyst (a small hard, red sore spot). They think it is similar to an acne pimple and will go away on its own. As the cyst gets bigger, it gets redder and hurts more. The red area might break open and bleed or leak pus-like drainage.
A pilonidal cyst is a sac filled with debris and hair that occurs in the area at the top of the crease of the buttocks overlying the tailbone (sacrum). This cyst and the overlying skin in the area can become infected, forming a painful abscess.
Most experts believe that the cysts arise due to trauma to the area that results in ingrown hairs. Pilonidal cysts often contain hair when excised, but hair follicles have not been demonstrated in them, suggesting that the hair may have been introduced from outside the cyst. Pilonidal disease was a common problem among servicemen during World War II, thought to be due to the mechanical trauma of riding in jeeps, trucks, and tanks.
It is not clear why pilonidal cysts form. At one time, it was thought pilonidal cysts might be congenital (a person is born with them) arising from embryologic cells that were in the wrong place early in development or due to repeat trauma (jeep driver's disease). It is now thought that small groups of hairs and debris (dead skin cells and bacteria) get trapped in the pores of the skin in the upper cleft of the buttock and form a "sinus," or pocket, that grows to become an abscess. This abscess forms under the skin (subcutaneously) and can result in scar tissue that can become infected repeatedly.
A doctor will diagnose a pilonidal cyst by first doing a physical examination. A pilonidal cyst looks like a lump, swelling, or abscess at the cleft of the buttock with tenderness, and possibly a draining or bleeding area (sinus). The location of the cyst at the top of the buttocks makes it characteristic for a pilonidal cyst.
It has been suggested that raw garlic applied directly to the cyst may help with infection, however, it can be extremely irritating to the skin and the open wound. Talk to your doctor before using any herbal supplement or natural remedy as some may interact with medications you are on. In addition, if your cyst has been drained and is open, you need to follow your doctor's instructions.
Treatment for pilonidal cysts involves draining the infection (abscess), usually by lancing open the wound. A procedure called an "incision and drainage" (I&D) is performed either using local anesthesia or general anesthesia; an I&D drains pus and debris from inside the cyst cavity. Pit picking is a non-excision procedure that involves a lateral (side to side) incision that drains the cyst, and the midline pits leading under the skin are removed.
If extensive scar tissue or chronic sinus tract is found in the pilonidal cyst area, a more extensive excision surgery may be needed for removal of the abscess. A pilonidal cystectomy removes the cysts or tracts that extend from the sinus. The wound may be left open with gauze packing or sutured shut. A cleft lift/modified Karydakis procedure only removes scarred skin, and not deeper tissue, and the incision is more to the side for improved healing. Other types of surgeries for pilonidal cyst include flap procedures such as the Limberg flap, Z-plasty, and rotational flap, which remove larger amounts of tissue. They are usually not a first line of surgical treatment.
Recovery time for pilonidal cyst surgery varies depending on whether you are left with an open or closed wound. If you have an open wound (tissue is removed, leaving a cavity, and the body heals from the inside out) it can take eight weeks for it to heal into a patch of scar tissue. If you have a closed wound (sutured by the doctor), healing is much faster, however, there is a greater chance for reinfection which can delay healing. Recovery time for the cleft lift/modified Karydakis procedure is about four weeks. In general, inflammation will last up to six days, and growth of new tissue continues for about two months.
The only time nonsurgical treatment for a pilonidal cyst is considered is if the cyst is minor and symptoms are mild and infrequent. Prevent the cyst from getting worse by using good hygiene, exfoliating the area, sitting with good posture, and using a coccyx cushion.
A primary care provider (PCP), such as a family practitioner, internist, or pediatrician, may diagnose a pilonidal cyst. A dermatologist may also be seen because many patients believe it's a skin-related problem. You may also see an emergency medicine specialist in a hospital emergency department.
The prognosis for a pilonidal cyst is generally good, and often the cyst can be cured with surgery. Unfortunately, reoccurrence of abscesses is frequent if extensive scar tissue or sinus formation occurs. Surgical treatment can be curative although, even with surgery, a small amount of cysts may reoccur. Complications include infection or scarring to the area.
In people prone to, or with risk factors for pilonidal cysts, modifying risk factors may help prevent flare-ups. Prevention of pilonidal cysts involves proper hygiene. Keeping the area clean and hair-free and exfoliating are the first steps. Losing weight and avoiding clothing that chafes the coccyx area helps prevent inflammation or infection. Prevention also entails proper sitting posture that can aggravate the tailbone area, and use of a coccyx cushion to keep pressure off the tailbone (a hemorrhoid "donut" pillow is not adequate for pilonidal cyst patients).
Pilonidal (meaning nest of hair) cysts or abscesses occur around the coccyx, just above the crack of the buttocks. They are usually caused by repetitive friction on the area but may begin with too much sitting, trauma or excessive sweating. Under these conditions, a hair follicle can become infected causing an abscess or boil, leading to a tract or small channel from the source of infection to the surface of the skin.
These cysts usually begin gradually and it's best to begin self care as early as possible. Although heat may reduce your pain, it's important to keep clean and dry and remove any stray hairs around the area to reduce the risk of infection. If a pilonidal sinus becomes infected, it should be treated as soon as possible as it's likely to get worse.
This chain of events explains 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. (1)
According to another theory, as deep layers of the skin stretch, the hair follicle enlarges and ruptures, and then cyst forms around the follicle that ruptures. The follicle is the structure from which a hair grows out. (6)
Treatment to drain a cyst is typically completed 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. This is commonly known as an I&D (incision and drainage). (10)
Some people also develop a chronic condition, where cysts recur even after surgical treatment. According to research published in 2018 in the Journal of Surgical Research, the recurrence of pilonidal disease after treatment is as high as 30 percent. (15)
Sometimes called the Cleft procedure, this surgery removes all the skin covering the involved area. Then, the surgical wound is closed by rotating other tissue to cover the area. The rotating of tissue causes the gluteal cleft to shift. This means that the butt crack will appear off-center. This is not noticed when your child has on clothing. This surgery is done by a plastic surgeon and is typically done on patients who have severe disease.
These cysts seem to be caused most often by an ingrown hair. A hair grows back under the skin or skin grows closed 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.
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. 2b1af7f3a8