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Pilonidal Cyst
(Pilonidal Sinus, Pilonidal Abscess)

Definition:
A pilonidal cyst is a fluid-filled developmental defect at the base of the spine, or “tailbone” area.

The terms cyst, sinus, and abscess refer to different stages of the disease process. A cyst is not infected. An abscess is a pocket of pus. A sinus is an opening between a cyst (or other internal structure) and the outside.

When a pilonidal cyst gets infected it forms an abscess, eventually draining pus through a sinus. Pilonidal cysts are harmless until they get infected, at which point they form an abscess that causes pain, a foul smell, and drainage. This event is more likely to occur in young Caucasian men with abundant hair in the region.

This condition is not serious, but since it is an infection like a boil or carbuncle, it can enlarge, become quite uncomfortable, and should therefore be treated.

Causes:
A pilonidal condition may be congenital or acquired. If congenital, it probably began as a defect that existed when you were born. Sometime later, the defect allowed an infection to develop. If acquired, it may be the enlargement of a simple hair follicle infection or the result of a hair penetrating the skin and causing an infection.

Risk Factors:
The following factors increase your chance of developing a pilonidal abscess:
  • Personal or family history of similar problems (eg, acne, boils, carbuncles, folliculitis, sebaceous cysts)
  • Large amounts of hair in the region
  • Tailbone injury
  • Horseback riding, cycling
Symptoms:
If you experience these symptoms, they are in all likelihood due to a pilonidal abscess that needs to be treated by your physician:
  • Painful swelling over your sacrum (just above your tailbone)
  • A foul smell or pus draining from that area
Diagnosis:
Your doctor will ask about your symptoms and medical history, and perform a physical exam. You will be referred to a surgeon for treatment. There are no diagnostic tests required.

Treatment:
Talk with your doctor about the best treatment plan for you. The choice of treatment will depend on the extent of the condition and your general overall health. Treatment options include the following:

Home Treatment
As with all localized infections under the skin, hot water soaks will help draw out the infection. This will not suffice by itself, but it will hasten resolution.

Incision and Drainage (I & D)
As a temporary measure, the abscess is sliced, the pus drained out, and the wound packed with sterile gauze so that it heals from the inside out. This treatment usually does not cure the problem because abnormal tissue remains.

Excision
To completely cure the condition, all involved tissue usually needs to be removed. This is a more extensive surgical procedure than simple I & D. The surgical wound may be closed with sutures or left open to heal from the inside.

Laser Hair Removal
There are recent reports that laser hair removal in the area may be effective treatment for pilonidal cysts.

Prevention:
To help reduce your chances of getting a pilonidal abscess, take the following steps:
  • Keep the area clean and dry
  • Avoid prolonged sitting on hard surfaces
  • Remove hair from the area
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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