They are sacs full of hair and skin remnants that are formed in the upper part of the crease of the buttocks above the sacrum.
A painful abscess can form if the cyst and the skin covering it become infected.
Pilonidal cysts are caused by groups of hairs and debris trapped in the pores of the skin in the upper groove of the buttocks, forming an abscess.
The risk factors for pilonidal cysts include being male, sedentary, having thick body hair, family history, being overweight and previous pilonidal cysts.
What is a pilonidal cyst?
A pilonidal cyst is a sac filled with debris and hair that occurs in the area at the top of the crease of the buttocks that covers the coccyx (sacrum). This cyst and the skin that lines the area can become infected, forming a painful abscess.
It is not clear why pilonidal cysts form. At one time, it was thought that pilonidal cysts could be congenital (a person is born with them) that arise from embryonic cells that were in the wrong place at the beginning of development or due to repeated trauma (disease of the jeep driver).
It is now believed that small clumps of hair and debris (dead skin cells and bacteria) are trapped in the pores of the skin in the upper cleft of the buttocks and form a “breast” or sac, which grows to become an abscess. .
This abscess forms under the skin (subcutaneously) and can cause scars that can be repeatedly infected.
Some babies are born with a cleft just above the crease of the buttocks called a sacral dimple. If the sacral dimple becomes infected, it can become a pilonidal cyst.
Risk factors for pilonidal cysts include the following:
- Male dominance (four times more frequent than in women).
- Young age (more common in men of 20 years).
- Sedentary lifestyle
- Thick hair.
- Family history.
- Local shaving or skin damage due to friction.
- Overweight or obesity
- Anterior pilonidal cyst.
If a pilonidal cyst is not infected, there may be no symptoms. When a cyst is infected, the signs and symptoms include:
- Pain in the upper part of the buttocks.
- Low back pain
- Discharge of blood or pus (if the abscess breaks or “bursts”)
- Bad smell.
A doctor will diagnose a pilonidal cyst by first doing a physical examination. A pilonidal cyst is seen as a lump, swelling or abscess in the cleft of the buttock with sensitivity, and possibly a drainage or bleeding area.
The location of the cyst on the upper part of the buttocks makes it characteristic of a pilonidal cyst.
If the infection is severe, blood tests can be performed for diagnosis. There is usually no need for imaging tests in cases of pilonidal cysts.
The treatment of pilonidal cysts involves the drainage of the infection (abscess), usually when the wound is opened by puncture. A procedure called “incision and drainage” (R & D) is performed using local anesthesia or general anesthesia; an R & D drains pus and debris from the inside of the cyst cavity.
Searching is a procedure without excision that involves a lateral incision (from one side to another) that drains the cyst, and the holes in the midline that lead under the skin are removed.
If extensive scar tissue or a chronic sinus tract is found in the area of the pilonidal cyst, a more extensive resection surgery may be necessary to remove the abscess.
A pilonidal cystectomy removes cysts or tracts that extend from the breast. The wound can be left open with gauze or closed suture.
A Karydakis procedure of cleft / modified lifting only removes scarred skin, and not the deeper tissue, and the incision is further to the side for better healing.
Other types of surgeries for the pilonidal cyst include flap procedures such as the Limberg flap, Z plasty, and rotational flap, which remove large amounts of tissue. In general, they are not a first line of surgical treatment.
If there is a serious infection (cellulitis or sepsis ) or if a patient is immunosuppressed(patients with HIV / AIDS, cancer chemotherapy, treatment with steroids or other immunomodulatory drugs ), antibiotics are usually prescribed and hospitalization may be necessary.
The recovery time for pilonidal cystic surgery varies depending on whether you have open or closed wounds. If you have an open wound (tissue is removed, leaving a cavity and the body is healthy from the inside out) it can take eight weeks for it to heal into a patch of scar tissue.
If you have a closed wound (sutured by the doctor), the healing is much faster, however, there is a greater possibility of reinfection that can delay healing. The recovery time for the fissure lift / modified cariakis procedure is approximately four weeks.
In general, the inflammation will last up to six days and the growth of new tissue will continue for approximately two months.
The only time the non-surgical treatment for a pilonidal cyst is considered is if the cyst is mild and the symptoms are mild and infrequent. Avoid that the cyst worsens using good hygiene, exfoliating the area, sitting with good posture and using a cushion for the coccyx.
Home remedies are meant to relieve pain and swelling. These home treatments include the following:
Sitz baths: Sitting in a tub of warm water up to the hips can relieve pain and may reduce the chances of the cyst getting worse.
Supplements of vitamin C and zinc: can help in the healing process. Vitamin A also helps with tissue repair. Consult a doctor for the correct dose of these supplements.
Essential oils, such as tea tree oil and sage oil, can help soothe the cyst and can even help fight infections.
A product called No Bump Rx helps prevent ingrown hairs.
Castor oil applied to the cyst can help reduce inflammation.
A cushion or pillow for coccyx can provide support and comfort while sitting.
Regular exercise helps improve blood flow, which can help healing.
It has been suggested that raw garlic applied directly to the cyst may help with the infection, however, it can be extremely irritating to the skin and the open wound.
Talk to your doctor before using any herbal supplement or natural remedy, as some may interact with the medications you are taking. Also, if your cyst has been drained and is open, you should follow your doctor’s instructions.
What types of doctors treat pilonidal cysts?
A primary care provider (PCP), such as a family doctor, internist or pediatrician, can diagnose a pilonidal cyst. You can also see a dermatologist because many patients believe it is a problem related to the skin.
You can also see an emergency medicine specialist. If it is necessary to drain the cyst, a primary care physician, an emergency doctor, a general surgeon or a colorectal surgeon can perform the procedure.
What is the prognosis?
The prognosis for a pilonidal cyst is usually good and, often, the cyst can be cured with surgery. Unfortunately, recurrence of abscesses is common if extensive scarring or breast formation occurs.
Surgical treatment can be curative, although, even with surgery, a small amount of cysts may reappear. Complications include infection or scarring in the area.
In people prone to or with risk factors for pilonidal cysts, modification of risk factors can help prevent outbreaks. The prevention of pilonidal cysts implies adequate hygiene. Keeping the area clean and hairless are the first steps.
Losing weight and avoiding clothing that irritates the coccyx area helps prevent inflammation or infection.
Prevention also involves a proper sitting posture that can aggravate the coccyx area and the use of a coccyx cushion to maintain pressure outside the coccyx (a “donut” pillow for hemorrhoids is not suitable for patients with pilonidal cyst).