Most of the readers might not be very familiar with the term pilonidal cyst. The term “pilonodal” is derived from Latin word which means hair (pilus) and nest (nidus). Pilonidal cyst literally means abnormal bag or pocket of cells that is formed in the skin usually near the tailbone at the cleft or partition of the buttocks. It may rarely occur in other parts of the body like armpit and naval region. Mostly a pilonidal cyst is a small depression or pit, which is present right from the birth. It can be small as a dimple or it may form a deep tract with hair in or around it. The pilonidal cyst consists of hair, skin debris, and other abnormal tissues. Pilonidal cyst is very common in young males, below 30 years of age. It is very rare after 40 years. Pilonidal cyst is usually harmless, but in case if it gets infected it might become inflamed and fluid might drain causing pain. Many argue that a pilonidal cyst is not a cyst but an abscess (enclosed collection of liquefied tissue called as pus).
Causes
The exact cause of pilonidal cyst is still under argument. It is said that factors that causes friction and pressure like skin rubbing against another skin, wearing tight clothes, bicycling, or sitting for a long period of time makes the hair penetrate deep into the skin. Another theory states that normal stretching or motion of deep layer of skin causes the hair follicles to burst below the skin, then over time a cyst develops over the ruptured follicle. And also, some children are born with a small pit or indentation or sacral dimple near the cleft of the buttocks, which might get infected, forming a pilonidal abscesses.
Symptoms
Pilonidal cyst usually does not show any signs and symptoms, it may just appear as a small pit on the skin surface. It may appear as a lump over the cleft in the buttocks region. When infected, the person may have pain, redness, and swelling in the bottom spine. In some, it may cause fever. There may be drainage of fluid or blood with foul odour.
Diagnosis
Healthcare provider should be contacted if the person notices redness, pain, swelling, and fluid drainage around the pilonidal cyst. Diagnosis mostly is done by medical history and physical appearance. Information like – changes in the appearance of pilonidal cyst, what changes are seen, what symptoms does the patient experience, does the patient feels numb or difficulty moving the legs, and changes in the bladder control – will be important for diagnosis. Rarely, tests will be done to check whether the cyst has spread to the spine.
Treatment
Pilonidal cyst usually does not go away on its own; it requires surgical intervention in most of the cases, although it seems to get better after antibiotics and lancing treatment. Mostly pilonidal cyst may go into a dormant phase for many years giving the sufferer a false sense of escape. The primary treatment for pilonidal cyst includes numbing the region with local anaesthesia and opening the abscesses and draining out the fluid, removing the hair, and clearing the debris from the abscesses, finally the region is dressed up well for internal healing. In many, this treatment alone is enough and no further treatment is required. Sitting in warm tub may help relieve pain. A surgical treatment is required if there is a recurrence of pilonidal cyst or many sinus tracts are present. There are two surgical options for treating pilonidal cyst.
Open wound surgery: The surgeon will cut open the cyst and drain away all the pus, hair, and debris. Then the wound will be left open and packed with dressing to allow fast healing from inside. This procedure usually requires a long recovery time but the chance of recurrence is very minimal.
Closed wound: After draining the content from the cyst, the surgeon will stitch the wound and close it, the healing time is fast with this procedure but the chance of recurrence is very high. Therefore, to improve healing and to reduce the chance of recurrence, the surgeon creates an incision to create a flap of skin therefore the stitches do not come near the buttocks region where healing is really very difficult.
After surgery, it is very important that the wound is taken care properly. The patient should consult the doctor about after care procedures. Shaving the region around the surgical area is very important to avoid hair entering the wound again.
Outlook
Pilonidal cyst requires proper cleaning and draining out the fluid with doctor’s assistance. Sometimes, the cyst bursts on its own but even then doctor’s intervention is required to clean out the content completely and help in fast healing. Proper after care is essential to avoid recurrence of the wound. Discuss all the treatment and preventive measures with doctor so that the cyst doesn’t come back and heals quickly.
