A pilonidal cyst is a pimple-like cyst typically located in the sacrococcygeal region of the body, usually near the top of the intergluteal cleft (also referred to as the natal cleft). Rarely, pilonidal cysts may also manifest between digits.¹ This common condition is seen most frequently in men who are between 16 and 24 years old. The name “pilonidal” is derived from Latin and literally means "nest of hair" because this condition frequently involves a hair follicle. The pit of the pilonidal cyst contains hair and skin debris that produce a foreign body reaction, resulting in localized inflammation and pain.

Causes of Pilonidal Cysts

There are two categories of pilonidal cysts: acquired and congenital. Congenital pilonidal disease is the result of a defect present at birth. Acquired pilonidal conditions are the result of ingrown hairs, foreign hairs entering a hair follicle, or trauma to the area of the body. The exact cause of pilonidal cysts is unknown, but they are believed to be caused by loose hairs pressing into the skin by clothing-induced friction.

Wound Care Options for the Pilonidal Cyst

This condition was once considered extremely common, manifesting in servicemen during World War II. Long hours spent riding in vehicles over rough terrain could end in natal cleft infections, earning pilonidal cysts the nickname, "Jeep disease."² Dog groomers and hairdressers are at higher risk because of their exposure to cut hair that can embed itself in hair follicles of the hands.¹

Risk Factors for Pilonidal Cysts

There are a number of factors that increase the likelihood of developing a pilonidal cyst, including:

• Male gender
• Pubescent to young adult age
• Genetic predisposition to acne, boils, folliculitis, and sebaceous cysts
• A significant amount of body hair growth in the area; stiff texture of hair
• Exposure to foreign hairs (such as in dog groomers and hairdressers)
• Traumatic injury to the coccygeal area
• Prolonged sitting resulting from occupation or leisure activities (cycling, horseback riding, or long-distance driving)

Symptoms of Pilonidal Cysts

Pilonidal cysts generally manifest as pimples but can have a variety of sizes and forms. The symptoms of developing infection in a pilonidal cyst include:

• Inflammation, pain, redness, and swelling
• Drainage of pus or blood from the inflamed area
• An unpleasant odor accompanying pus
• Fever

Complications of Pilonidal Cysts

Once infected, a pilonidal cyst is referred to as a pilonidal abscess, and it will need treatment to be resolved. An infected pilonidal abscess will typically have chronic purulent drainage from the opening, which appears as a small dimple on the surface of the skin. Such an infection may be extremely painful.

Treatment of Pilonidal Cysts

An infected pilonidal cyst can be treated in a number of different ways. Antibiotics alone are ineffective for closing the sinus tract. Over-the-counter anti-inflammatory drugs can help to relieve pain. Hot, moist compresses applied several times a day directly to the cyst may relieve symptoms by facilitating drainage. Soaking in a warm bath (or sitz bath) may have a similar effect.³ The only way to eliminate pilonidal cysts is through procedures that eliminate the sinus tract permanently. One such minor surgical procedure involves lancing and draining the infected area. During this procedure, the offending hair and follicles are removed, and the incision is left open and packed with sterile gauze.

The resulting wound will take about three weeks to heal, and the dressing must be changed regularly in the interim.³ Endoscopic ablation of the pilonidal sinus is a less invasive, non-scarring procedure that involves irrigating the sinus, removing hair and debris, and then cauterizing the opening. This is an optimal choice over more invasive operations in terms of healing time.⁴ A pilonidal cystectomy is a procedure recommended in cases of recurrence. This surgery, performed with the patient under general anesthesia, completely removes the cyst and the pilonidal sinus tracts. Complete healing from a cystectomy will take one to three months, with regular activities resumed within two to four weeks. The recurrence rate for pilonidal cysts is around 30%, which is why preventative measures are important.³

Prevention of Pilonidal Cysts

For individuals at high risk of developing pilonidal cysts, there are a few ways to reduce the chances of cyst development or recurrence. These include:

• Keeping the natal cleft area clean and dry
• Removing hair growing near this area
• Avoiding sitting for extended periods of time
• Losing weight

Conclusion

The greatest risk factor for developing a pilonidal cyst is a personal history of the condition. Individuals at high risk can take precautions to avoid developing a pilonidal cyst or abscess, but once one has developed, there are a number of options for treatment. Self-treatment can alleviate pain and discomfort, but to truly cure a pilonidal cyst, medical intervention is required.

References

1. Stern PJ, Goldfarb CA. Interdigital pilonidal sinus. N Engl J Med. 2004;350:e10.

2. Fitzpatrick, EB, Chesley, PM, Oguntoye, MO, Maykel, JA, Johnson, EK, Steele, SR. Pilonidal disease in a military population: how far have we really come? Am J Surg. 2014;207:907–914.

3. Armstrong JH, Barcia PJ. Pilonidal sinus disease: the conservative approach. Arch Surg. 1994;129:914–918.

4. Neola B, Capasso S, Caruso L, Falato A, Ferulano GP. Scarless outpatient ablation of pilonidal sinus: a pilot study of a new minimally invasive treatment. Int Wound J. 2016;13(5):705–708.