Pilonidal Cysts & Disease

Pilonidal cysts, sinuses and abscesses are a spectrum of disease affecting the skin and deep tissues of the gluteal cleft or area just above the tailbone between the buttocks. They are essentially a pocket and sinus tract of inflammation and trapped hair that can borough deep into the skin surface. Patients may initially experience a small opening to the skin called a pit, which may track and branch to deeper tissues, known as a sinus. Hair can then become clogged or stuck in the sinus and lead to further inflammation and infection of the pocket or cystic cavity beneath the skin. Eventually the cyst may become infected enough to form an abscess (a pocket of pus). Abscesses may enlarge and drain through the sinus to the skin or may require an incision to be treated. Patients may experience multiple pits and sinuses at the same time, or over time.

Pilonidal disease is more common in men than in women, and generally occurs when patients are younger than 40. Historically, pilonidal cysts were once called “Jeep disease” because high numbers of soldiers during World War II presented with them. This wave of occurrences is part of a body of evidence supporting the theory that irritation and tissue trauma in the tailbone region can cause or encourage pilonidal cysts. While men in their twenties are the most likely to experience pilonidal cysts overall, they can occur in anyone.

How They Present

Typically, a patient notices a pilonidal cyst when it becomes infected and abscesses. Patients may first notice pain and inflammation (marked by heat, swelling, redness and tenderness) at the site of the cyst. There may be spontaneous drainage of pus. Pilonidal abscesses can develop gradually or appear and grow very rapidly, often requiring urgent intervention within a matter of days. After the abscess resolves, persistent occasional drainage from openings in the skin may be seen. An abscess may recur if the cyst and sinus are not removed.

Treatment Options

The course of treatment for pilonidal disease varies. The disease may be self limiting and only require treatment with soaks, shaving and occasional antibiotics. The application of moist heat is generally a good first aid step for abscesses. Sitting in a warm bath a couple of times a day can help ease the pain of inflammation, and when applied early enough, may reduce the patient’s chances of needing surgical treatment.

Some patients may require office drainage or surgery for more advanced infection. Some cysts may be excised with a local anesthetic in a clinician’s office. Others that are larger, or that organize more deeply within the tissue and grow to be painful without forming a “head” quickly, may require a fully anesthetized surgical removal.
Patients with the most severe cases, or those that develop multiple recurrences, may require more advanced surgeries.

Healing and Prevention

When cysts develop and grow, they create a cavity for themselves, and this cavity can refill if the cyst isn’t excised correctly and the site properly healed. While some smaller pilonidal cyst wounds can be closed immediately, this is fairly uncommon, and more often the cyst excision site is intentionally left open. The patient, or someone assisting the patient, typically uses sterile saline and sterile cotton gauze to pack the wound, changing this dressing frequently for as long as a few weeks. This allows the wound to heal gradually from the inside outward, rather than the skin on the surface healing first and enclosing a cavity in which a cyst could reform. For some patients, particularly those who experience chronic pilonidal disease, it is wise to pay lifelong attention to the area of the cysts, making sure to keep thick body hair trimmed and the site clean.

The Saleeby & Wessels Proctology Approach

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