(P) Pilonidal disease (pilonidal cyst): causes, symptoms, treatment

We talk about pilonidal disease (pilonidal cyst) in this article. We tell you what pilonidal disease is, what causes it, how it manifests itself, how it is treated and we see how it can be prevented.

What is pilonidal disease (pilonidal cyst)?

A pilonidal cyst (also called pilonidal cyst disease, intergluteal pilonidal disease, or pilonidal sinus) is a skin condition that occurs in the fold of the buttocks, anywhere from the tailbone to the anus, and is caused by a skin infection. A pilonidal cyst can be extremely painful, especially when the person is sitting down. Pilonidal disease is a common condition, but many people feel too embarrassed to even mention it to their doctor. Pilonidal cysts can cause pain and need to be treated. Pilonidal disease can be acute or these cysts can be chronic (they can come back). If left untreated, chronic pilonidal cysts can also lead to abscesses (swollen pockets of infection) and sinus cavities (empty spaces under the skin). Anyone can develop a pilonidal cyst, but certain people are at greater risk:

• men: they are three to four times more likely to be diagnosed with a pilonidal cyst than women;
• people between puberty and 40: the average age is between 20 and 35;
• people who sit all day: such as truck drivers and office workers;
• people who are overweight/obese;
• people with thick or coarse body hair: this characteristic can be inherited;
• people who wear tight clothes: this can make the skin condition worse.

In some cases, a pilonidal cyst can be hereditary (it can be inherited from a family member). Family history can play a role in determining whether you have pilonidal cysts, for example if coarse body hair runs in the family. A pilonidal cyst is a non-contagious skin condition. Pilonidal cysts are generally caused by ingrown hairs.

Causes of pilonidal disease

The cause of most pilonidal cysts is loose hairs that pierce the skin. Friction and pressure from chafing skin, tight clothing, riding a bicycle or sitting for long periods of time can force the hair into the skin. The body creates a cyst around the hair to try to push it out. Most pilonidal cysts form at the level of the coccyx. People who groom animals or cut hair can develop a cyst between the fingers.

Risk factors of pilonidal disease

Factors that may increase your risk of having a pilonidal cyst include:

• that you are a young male adult;
• overweight;
• inactive lifestyle;
• sitting for long periods of time (sedentaryism);
• hairs thick and spiky.

Symptoms of pilonidal disease

A pilonidal cyst may not cause symptoms. But if it is infected, the skin around the cyst may be inflamed and painful. Symptoms of an infected pilonidal cyst include:

• a dimple near the top of the buttock fold;
• pain;
• inflamed skin;
• pus or blood oozing from an opening in the skin;
• smell from the oozing pus.

When should the doctor be consulted?

If you notice any symptoms of a pilonidal cyst, see your emergency doctor.

Complications of pilonidal disease

Some people have pilonidal cysts that become infected again and again over a long period of time. Without treatment, these people may be at increased risk of developing a type of skin cancer called squamous cell carcinoma. The pilonidal cyst should be visible to the naked eye. The doctor may notice what appears to be a pimple or cyst that is oozing. Very rarely, doctor may order a CT scan or MRI to look for sinus cavities that may have formed under the skin.

Treatment for pilonidal disease

The person diagnosed with one or more pilonidal cysts will receive a treatment plan that best suits the individual case. Depending on the severity of the patient’s symptoms, they may or may not need surgery to remove the pilonidal cyst. There are several other treatment methods available besides surgery, including:

• cyst drainage: this procedure can take place right in the doctor’s office. A small incision (cut) will be made to open and drain the fluid from your infected cyst;
• phenol (an acidic chemical compound) injections: can treat and prevent mild to moderate pilonidal cysts;
• antibiotics: can treat skin inflammation. However, antibiotics alone cannot cure pilonidal cysts;
• laser therapy: can remove hair that might otherwise ingrown and cause more pilonidal cysts to reappear;
• warm compress: durination can also be improved with a warm compress on the affected area to soothe the skin.

Can a pilonidal cyst go away on its own?

Pilonidal cysts sometimes drain and disappear on their own. With chronic pilonidal cyst, symptoms may come and go over time.

Can pilonidal cysts be prevented?

There are several steps you can take to help prevent pilonidal cysts from occurring or to prevent them from coming back. These steps include:

• regular washing and drying of the buttocks (to keep the area clean);
• weight loss (if you are currently overweight);
• avoiding sitting for too long (if the job allows);
• waxing in the buttock area to avoid the appearance of ingrown hairs.

Although a pilonidal cyst itself is not life-threatening, it can become more difficult to treat and turn into a chronic condition if not treated right away. That’s why it’s important to get an exam at the first sign of any symptom of pilonidal disease. Always be open with your doctor about your symptoms and health concerns!