Pilonidal Cysts

A pilonidal (pronounced “py-luh-NY-dul”), also referred to as a pilonidal abscess, pilonidal sinus or a sacrococcygeal fistula, is a cyst or abscess near or on the natal cleft of the buttocks. The cyst essentially looks like a boil at the bottom of the tailbone and often contains hair and skin debris.

A pilonidal cyst can become infected and filled with pus. Once infected, the technical term is pilonidal abscess. Pilonidal abscesses look like a large pimple at the bottom of the tailbone. It is more common in men than in women and usually happens in young people up into their 40’s.

Pilonidal disease was discussed as far back as 1833, when Mayo described a hair-containing cyst located just below the coccyx. Hodge coined the term “pilonidal” (literally meaning ‘nest of hairs’) from its Latin origins in 1880, and, today, pilonidal disease describes a number of conditions, ranging from asymptomatic hair-containing cysts and sinuses to large symptomatic abscesses of the sacrococcygeal region (the region relating to both the sacrum [the lower vertebrae] and coccyx).

The onset of a pilonidal cyst infection is rare both before puberty and after the age of 40. Males are affected more frequently than females, probably due to their more hirsute nature. In a population study of 50,000 students the incidence in males was 1.1%, ten times more than in females, although many of these were asymptomatic. It occurs predominantly in white patients, typically in the late teens to early twenties, decreasing after age 25 and rarely occurs after age 45.*

Symptoms can vary and be present from a cyst the size of a small dimple to a large painful mass. The symptoms of an infected pilonidal cyst include:

  • Pain at the bottom of the spine
  • Swelling at the bottom of the spine
  • Redness at the bottom of the spine
  • Draining pus that may be clear, cloudy or bloody
  • Foul smelling pus
  • Fever
  • Nausea
Most doctors think that ingrown hairs cause pilonidal cysts. (Thus the name, pilonidal, which means “nest of hair”), since it is common to find hair follicles inside the cyst. Another possible explanation is that normal stretching or motion of deep layers of skin causes the enlargement and rupture of a hair follicle, the structure from which a hair grows. A cyst then forms around the ruptured follicle. Yet another theory is that pilonidal sinuses appear after an injury to the sacrococcygeal region.

Others have believed that pilonidal cysts appear after trauma to that region of the body. During World War II, more than 80,000 soldiers developed pilonidal cysts that required a hospital stay. People thought the cysts were due to irritation from riding in bumpy Jeeps. For a while, the condition was actually called “Jeep disease.”

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

  • Male gender
  • Caucasians
  • Family History
  • Personal or family history of similar problems such as acne, boils, carbuncles, folliculitis, and sebaceous cysts
  • Deep natal cleft (the groove between the buttocks; gluteal crease)
  • Obesity (also risk for recurrent disease)
  • Inactive lifestyle
  • Occupation or sports requiring prolonged sitting (horseback riding, cycling)
  • Excess body hair, especially hair in the region
  • Stiff or coarse hair
  • Poor hygiene
  • Local irritation or trauma prior to onset of symptoms
While the pilonidal cyst is not serious, it can become an infection and should therefore be treated. When a pilonidal cyst gets infected, it can also become extremely painful. Also, if a chronically infected pilonidal cyst is left untreated, there may be a slightly increased risk of developing squamous cell carcinoma, a type of skin cancer.

Pilonidal sinus disease has been surgically treated for more than 100 years. In many cases, such as a recurring infection, a plastic surgeon is ideally equipped to treat the condition. Excision of the cyst together with flap closure is often combined with laser hair removal, which we have found to be effective, and has also been shown to decrease recurrence. We use similar flap closure extensively in various other procedures we perform at The Institute for Advanced Reconstruction.

At The Institute for Advanced Reconstruction, we offer treatments for pilonidal cysts to improve the quality of life of our patients. An  initial consultation with our experts will assist in evaluating each individual case.

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