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Diseases and Conditions
Pilonidal cyst
From MayoClinic.com
Special to CNN.com

Introduction

Pilonidal cysts are pockets of skin in the crease of the buttocks near the end of the tailbone (coccyx). They usually begin where ingrown hairs push into the folds of the skin, which irritates and inflames the skin.

Not everything about pilonidal cysts is understood, but there are several well-known facts. Men are affected two to three times more often than are women, and the cysts typically affect those younger than 40.

Pilonidal cysts often cause discomfort. But the main concern is infection, which can result in a painful abscess. Treatment includes removing hair from the area and surgery to open and drain the cyst.

Signs and symptoms

The first sign of a pilonidal cyst is often a slight lump that can be felt over the tailbone in the buttock crease. If the pilonidal cyst becomes larger and inflamed, you may notice pain in the area of your tailbone that worsens with sitting.

The main concern is infection, which can result in a painful abscess. Signs and symptoms of an abscess include pain, localized swelling, redness, fever and drainage of pus.

Causes

A pilonidal cyst develops when body hair grows or is pushed into a pilonidal dimple or pit — a hollow space or cavity located in the crease of the buttocks near the end of the tailbone. As the hair grows inward, the cavity can get irritated and inflamed and may become infected. An infected pilonidal cyst is called a pilonidal abscess.

Pilonidal cysts are more common in men who have more body hair and in people who sit for prolonged periods of time on their job.

Risk factors

Certain factors can make you more susceptible to developing pilonidal cysts. These include:

  • Male sex
  • Obesity
  • Inactive lifestyle
  • Occupation requiring sitting
  • Excess body hair
  • Poor hygiene
  • Excess sweating

When to seek medical advice

If you notice any signs or symptoms of a pilonidal cyst, see your doctor. He or she can diagnose the condition by examining the lesion.

Complications

Infection is the main complication of a pilonidal cyst. An infected pilonidal cyst, referred to as a pilonidal abscess, is often very painful. A cyst that is painful, irritated or infected typically contains hair plus blood and clear or yellowish drainage that typically has a foul odor.

Treatment

Because every pilonidal cyst is unique to the person affected, doctors use a variety of methods to treat this condition. In mild cases, regularly shaving the area can resolve the problem. This prevents the hair from embedding into the skin.

First-time abscesses may need only simple incision and drainage. But if the cyst recurs or if there are multiple cysts or cavities, your doctor may recommend more extensive surgery. 

  • Incision and drainage procedure. During this procedure, you're given a local anesthetic to numb the area before your doctor opens and drains the cyst. Afterward, your doctor packs the wound so that it can heal from the inside out.
  • Surgery. Surgical treatment of recurrent pilonidal cysts usually involves opening and draining infected cysts and cutting away skin and flesh that cover any dimples or pits that could potentially develop into abscesses. The wounds are left open and packed to heal from the inside out. In some cases, the wound is partially sewn to prevent the wound from closing up prematurely. Surgery may be done with local, regional or general anesthesia.

Wound care treatment is extremely important after surgery for an infected cyst. Your doctor or nurse will give you detailed instructions on how to change the dressings. At home, you'll need to perform wet-to-dry dressings two to three times a day for several weeks. These dressings support a process called granulation, which helps to form new and healthy tissue from the inside out.

Bleeding and infection are the two most common complications after pilonidal cyst surgery. While changing the dressings, you may notice oozing of blood or clear fluid, which is normal. However, persistent bleeding that requires more than two or three dressing changes a day or drainage that is foul smelling isn't normal. See your doctor if you experience these symptoms.

Pilonidal cysts can become a chronic problem, recurring even after treatment. Or they can resolve without complications after surgery.

Prevention

To prevent future pilonidal cysts from developing:

  • Remove any hair from this area on a regular basis. Shaving or depilatory creams work well, but you may need laser treatments for hair removal.
  • Clean the area daily with glycerin soap, which tends to be less irritating. Rinse the area thoroughly to remove any soapy residue. Washing briskly with a washcloth helps keep the area free of hair accumulation.
  • Keep the area clean and dry. Don't use powders, oils or herbal remedies on this area.
  • Avoid sitting for long periods of time.

June 16, 2006

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