Pilonidal Cyst

What is a Pilonidal Cyst?

A pilonidal cyst is a cavity underneath the skin over the tailbone. Pilonidal literally means "nest of hair" because the cavity is often found to contain hair. Literature shows that it is an acquired disease and not inherited. You are not born with it.

What are the Symptoms?

Some people have no symptoms. Occasionally, pus accumulates in the cyst, causing an abscess to form. Then a patient will experience fever or pain and swelling in the tailbone area. Others will develop low-grade infections periodically. These patients experience milder, recurring episodes of pain and swelling.

Who is Affected?

This problem is more common in young adults and teenagers. This condition is rare in patients over 40 years of age. It is three times more common in men than women.

How is it Treated?

Patients with an acute abscess can generally be treated in the doctor's office. The doctor uses local anesthesia to numb the area. A small incision is made to allow for drainage of pus. This immediately relieves pressure and decreases pain. Daily cleansing of the area in the bathtub or shower is important to keep hair and other debris out of the wound. The patient should return for follow up until the wound is healed. Healing occurs rapidly, and usually the wounds are completely closed in three weeks. To help prevent reoccurrences and to aid healing after pilonidal surgery patients are often urged to keep the skin around the glutteal cleft free from hair either by shaving the area weekly or by use of a depilatory for at least three months.

For patients with repeated episodes, surgery may be required. This is done as an outpatient procedure in our Ambulatory Surgery Center. A variety of surgical techniques are utilized in our practice to remove the cyst.  Most commonly, the cyst is opened, cleaned, and allowed to heal from the inside out. Some of the surgeons prefer the approach described by Dr. Bascom in which an incision is made off the midline to open and empty the cyst.  This is felt in some hands to result in quicker healing and lower recurrence.

After surgery it is important to keep gauze in the wound to keep the skin edges separated until the wound fills in from the bottom. The patient will need to shower the wound frequently and repack it.  This often takes the assistance of a family member. The patient will be seen back in the office for follow up until the wound is healed. In some instances, a more complex procedure is necessary.

Will This Occur Again?

After surgery approximately 10 percent of patients will develop another cyst. One thing that can be done to prevent it is to keep the area free from hair with a depilatory cream.