Pilonidal Cyst: Symptoms, Causes & Treatment

What is a Pilonidal Cyst?

A pilonidal cyst (sacrococcygeal fistula) is an abnormal pocket in the skin that usually locates itself above the buttocks near the tailbone. The cyst looks much like a pimple and commonly contains hair and skin debris. If the cyst becomes infected it can result in a really painful abscess that requires clinical attention. Even the pressure from sitting can become uncomfortable. If an infection ensues, you may develop flu-like symptoms, too. An infected pilonidal cyst is known for causing fever, nausea, and vomiting.

Pilonidal cysts were first described in 1833 by Herbert Mayo. The term pilonidal is derived from the Latin words “pilus” (hair) and “nidus” (nest). While pilonidal cysts occur more frequently in men than in women, they are also more common in people of Middle Eastern and Caucasian descent than in other racial groups.

Without proper treatment, a pilonidal cyst can become seriously infected and make you quite ill. Because of this, it’s important to understand the signs and symptoms of a pilonidal cyst and get started on treatment early on.

What are the symptoms of a pilonidal cyst?

Pilonidal cysts often start out symptomless. You might feel a small bump, but nothing more. If the cyst gets infected, you’ll notice more severe symptoms. They may include:

  • Pain
  • Skin redness and warmth
  • Pus drainage
  • Blood drainage
  • A foul smell from the drainage
  • Fever

What are the causes of a pilonidal cyst?

A chronic skin infection that forms near your tailbone in the top crease of your buttocks, a pilonidal cyst is known for causing excruciating pain. They develop when hairs in the cleft of your buttocks grow into your skin and become infected. Risk factors include:
  • Being overweight
  • Sedentary lifestyle
  • Sitting for long periods
  • Naturally stiff, coarse hair

Who is affected by pilonidal cysts?

Though anyone can suffer from a painful, inflamed pilonidal cyst, this condition affects men more commonly than women. Pilonidal cysts are also more prevalent among young adults in their late teens, 20s and 30s.

How are Pilonidal Abscess treated?

There are two types of surgical procedures available to treat pilonidal disease; incision and drainage or complete excision of the cyst. Treatment for this condition varies on a case by case basis and is dependent on the severity of the infection.
The main technique for treating an infected pilonidal abscess is lancing the cyst and draining the pus within it. This is typically a simple procedure performed in the office under a local anesthetic.
Should an excision of the abscess be necessary, the area will be surgically opened and a complete debridement will be performed. This technique is often favored by physicians because there is a decreased risk in wound complications. Since the wound is being left open to heal, there is little risk of an actual wound infection.

How are Pilonidal cyst and sinus treated?

Complex or recurrent pilonidal disease are best treated by an operation. The goal of the operation is to remove the entire bed of disease that includes the sinus tracts and the cyst with extension of the incision all the way to healthy tissue layer overlying the coccyx (tailbone). Thereafter the wound is reconstructed and closed with the use of flaps. Flaps allow for mobilization of healthy tissue to allow a more easy and tension free wound closure that has a small chance of coming open. Historically, most proposed flap closure create an off midline scar that is not cosmetically appealing. Additionally other described surgical methods are associated with high complication and recurrence rate and prolonged wound healing and issues with pain control.

As such, we perfected a unique flap based operation that is associated with very low complication rates such as wound dehiscence (wound coming apart), wound infection or formation of seroma or hematoma (fluid collections in the wound). It further carries the huge advantage of a very cosmetic scar that is midline and recreates the midline gluteal (buttock) cleft or crease.

Cutting-Edge Flap-Based Outpatient Pilonidal Treatment Technique

Dr. Nasseri and Dr Barnajian are experts in the Los Angeles area in the treatment of pilonidal cysts. They have perfected a cutting-edge flap-based outpatient treatment technique to relieve their symptoms and minimize their chances of redeveloping. This technique has been perfected over the last decades to reach its current state. The flap procedure is called bilateral fasciocutaneous gluteal flaps with tie over sutures and incorporation of extracellular matrix. The flap with incorporation of cutting edge regenerative tissue has several advantages over other commonly described flaps:

  1. It is done as an outpatient procedure (patient goes home shortly after procedure)
  2. Most patients experience minimal pain after the operation
  3. The technique results in a very cosmetically desirable midline scar that aligns with the buttock crease
  4. It is associated with minimal rate of complications (wound infections, wound coming open)
  5. It is associated with near zero recurrence rate (chance of the disease coming back)

Dr. Nasseri and Dr. Barnajian have published on the technicalities and the great outcomes of this technique in peer review journals. They have produced high quality videos describing the technique. They have also delivered many educational talks to patients and other surgeons nationally who wish to learn about this this technique

Schedule A Consultation

You should book an appointment with the Pilonidal Institute right away if you have any of the symptoms above. Our doctors can evaluate your cyst, find a treatment, and help stop them from recurring.

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