PILONIDAL DISEASE

Pilonidal disease, often referred to as pilonidal cyst, is a common yet misunderstood condition affecting the skin at the top of the buttocks cleft. Though it may seem harmless at first, it can lead to discomfort, pain, and even infection if left untreated. it is a type of cyst that can develop at the bottom of the tailbone or coccyx. This cyst can become infected and filled with pus, causing discomfort and pain.

Causes

Historical Perspective: During World War II, a significant number of soldiers developed pilonidal cysts, leading to hospitalization. This phenomenon was attributed to irritation from riding in bumpy Jeeps, and the condition was colloquially referred to as “Jeep disease.” While this theory may have historical significance, it’s essential to recognize that pilonidal cysts can arise from various factors beyond wartime vehicle transportation.
Sacral Dimple: Some individuals may be predisposed to pilonidal cysts if they have a small dimple in the skin between their buttocks, known as a sacral dimple. Although typically harmless, this dimple can become infected, potentially leading to the formation of a cyst. While the exact connection between sacral dimples and pilonidal cysts is not fully understood, individuals with sacral dimples should remain vigilant for signs of infection and consult a doctor if symptoms arise.
Hereditary Factors: There may be a hereditary component to the development of pilonidal cysts. For instance, individuals with a family history of thick, coarse body hair may be more predisposed to developing cysts. While genetics can play a role, other environmental and lifestyle factors also contribute to cyst formation.
Bowel Problems: Pilonidal cysts typically do not cause direct issues with bowel function. However, due to the presence of bleeding as a symptom of pilonidal cysts, individuals may notice blood on toilet paper after a bowel movement, especially if they inadvertently aggravate the cyst during hygiene practices. This bleeding is a result of the cyst’s irritation and should prompt medical evaluation to address the underlying condition.

Prevalence

While exact numbers vary, pilonidal disease is relatively common, particularly among young adults. Men are more likely to develop this condition than women, and it tends to occur more frequently in individuals with a lot of body hair.

Symptoms

Pain, Redness, and Swelling: The onset of a pilonidal cyst often manifests as pain, redness, and swelling at the base of the spine. This discomfort may progressively worsen, particularly with prolonged periods of sitting or pressure on the affected area.
Drainage of Pus or Blood: A characteristic symptom of a pilonidal cyst is the presence of pus or blood draining from the cyst. This drainage may have a foul odor, particularly if the cyst is infected, indicating the need for prompt medical attention.
Tenderness and Sensitivity: The affected area may exhibit tenderness and sensitivity to touch. Patients may experience discomfort or pain upon palpation of the cyst or surrounding tissues.
Systemic Symptoms: In cases of infection or severe inflammation, individuals may experience systemic symptoms such as fever, nausea, or fatigue. These symptoms suggest a more advanced or complicated presentation of the cyst and necessitate immediate medical evaluation.

Risk Factors

Several factors increase the risk of developing pilonidal cysts. Here are some key risk factors associated with this condition:

Prolonged Sitting: People who spend most of their day sitting, especially in jobs that involve prolonged sitting, such as office workers or truck drivers, have a higher risk of developing pilonidal cysts. This is because constant pressure on the tailbone area can contribute to the formation of cysts. Prolonged sitting or lack of physical activity can promote the accumulation of sweat and debris in the buttock crease, leading to the formation of cysts.
Obesity: Being severely overweight is another risk factor for pilonidal cysts. Excess weight can increase pressure on the tailbone area, leading to irritation and the development of cysts.
Coarse or Thick Body Hair: Individuals with coarse or thick body hair may be more susceptible to pilonidal cysts. The presence of dense hair can increase the likelihood of ingrown hairs, which are believed to be a contributing factor to cyst formation.
Gender: Men are at a higher risk of developing pilonidal cysts compared to women. In fact, men are three to four times more likely to experience this condition. The reasons for this gender disparity are not entirely clear but may be related to hormonal differences or variations in hair growth patterns.
Age: Pilonidal cysts most commonly occur in individuals aged 20 to 35 years. While they can develop at any age, this demographic group is at the highest risk.
Poor hygiene: Inadequate cleansing of the tailbone area can allow bacteria and debris to accumulate, increasing the risk of infection and inflammation.

Researchers believe that pilonidal cysts are often caused by ingrown hairs, hence the term “nest of hair.” Inside the cyst, doctors may find hair follicles, further supporting this theory.

Is It Safe to Squeeze a Pilonidal Cyst?

No, squeezing a cyst can worsen the infection, cause bleeding, and lead to further irritation. It’s best to have it evaluated and treated by a doctor.

Diagnosis

Physical Examination: Your doctor will conduct a thorough examination, focusing on the crease of your buttocks, to assess for signs of a pilonidal cyst. They will inspect the area for the presence of a pimple, dimple, or bump that may be oozing fluid, indicative of a cyst.
Patient History: Your doctor may inquire about the duration and progression of symptoms, such as changes in the appearance of the cyst, the presence of leakage, and any associated symptoms you may have experienced.
In some cases, imaging tests such as ultrasound or MRI may be used to assess the extent of the cyst or abscess.
A healthcare provider may also perform a procedure called needle aspiration to drain fluid from the cyst for analysis.

Treatments

Treatment options for pilonidal disease vary depending on the severity of the condition and may include:

Natural Drainage: In some cases, a pilonidal cyst may open and drain spontaneously. If this occurs, it’s essential to maintain proper hygiene by keeping the area clean and dry to prevent infection.
Antibiotics: Antibiotics may be prescribed if there is inflammation surrounding the pilonidal cyst. However, antibiotics alone will not resolve the cyst or promote its disappearance.
Laser Therapy: Laser therapy can be utilized to remove hair from the affected area, reducing the likelihood of ingrown hairs and potentially preventing the recurrence of cysts. While it does not cure existing cysts, it may help prevent future ones.

Medical Procedures

Drainage: For initial or uncomplicated cysts, drainage may be performed. This involves making an incision into the cyst, draining its contents, and removing any hair follicles. The wound is left open and packed with gauze to facilitate healing. This procedure is typically performed under local anesthesia.
Surgery: Surgery may be necessary for chronic or recurrent pilonidal cysts or in cases where complications have arisen. Different surgical techniques may be employed, including:
- Marsupialization: During this procedure, the cyst is drained, and the wound edges are stitched together to create a pouch. This outpatient surgery is performed under local anesthesia, and while it requires a longer healing time, it minimizes the need for daily gauze packing.
- Incision, Drainage, and Closure: In this approach, the cyst is drained, and the wound is fully closed after surgery. While it avoids the need for postoperative gauze packing, it may increase the risk of cyst recurrence and is typically performed in an operating room by a specialized surgeon.

What is the best treatment for a Pilonidal Cyst?

Draining is typically the preferred initial treatment for pilonidal cysts. This involves making a small incision to drain the cyst and packing the wound with gauze. It’s performed under local anesthesia and may take several weeks to heal.

Home Care Tips

Warm Water Soaks: Soaking in a tub of warm water can help alleviate pain and promote drainage of the cyst. This can provide temporary relief and aid in the healing process.
Over-the-Counter Pain Medication: Nonprescription pain relievers, such as acetaminophen or ibuprofen, can be taken according to the recommended dosage to manage discomfort associated with the cyst.
Hygiene and Wound Care: Keeping the cyst and the surrounding area clean and dry is essential for preventing infection and promoting healing. Gently cleansing the area with mild soap and water and patting it dry can help maintain proper hygiene.

Will a Pilonidal Cyst Go Away on Its Own?

In some cases, a cyst may spontaneously open and drain. However, it’s important to keep the area clean and dry if this occurs.

Pilonidal Cyst Recovery

Follow Instructions: Adhere to your doctor’s guidance regarding home care, especially if gauze packing is required. Maintain cleanliness in the area and monitor for signs of infection.
Regular Check-ups: Attend scheduled follow-up appointments to allow your doctor to monitor the healing progress of your cyst.
Precautions: Even after successful treatment, be aware that pilonidal cysts can recur. Remain vigilant for any symptoms indicating a potential recurrence.

Complications

Infected Pilonidal Cyst: An infected cyst, known as an abscess, can be extremely painful and may exhibit symptoms such as foul-smelling pus, fever, and nausea. In severe cases, the infection can spread systemically, posing a life-threatening risk.
Recurrence: Despite medical intervention, some individuals may experience chronic pilonidal disease characterized by the recurrent formation of cysts. This condition necessitates ongoing management and surveillance to mitigate complications.

Prevention

Avoid Prolonged Sitting: Stand up or walk around periodically to reduce prolonged pressure on the buttocks, which can contribute to the development of pilonidal cysts.
Maintain Hygiene: Regularly wash the area around your buttocks to keep it clean and minimize the risk of infection.
Healthy Weight: Aim to maintain a healthy weight, as being overweight can increase your risk of developing pilonidal cysts.

When to See a Doctor

Increased Pain with Prolonged Sitting: If you notice escalating pain, particularly after extended periods of sitting, it is advisable to contact your healthcare provider for further assessment and management.
Visible Signs of Inflammation: Any swelling, redness, or soreness along the buttock crease or the presence of a dimple in the area warrants medical attention, as these may indicate the development or exacerbation of a pilonidal cyst.
Drainage of Pus or Blood: If you observe any discharge of pus or blood from the cyst, it is essential to seek medical care promptly to prevent infection or complications.
Systemic Symptoms: The onset of systemic symptoms such as fever, nausea, or profound fatigue suggests a more severe infection or inflammation and requires immediate medical intervention to prevent further complications.

Outlook/Prognosis

The prognosis for pilonidal disease varies depending on the severity of the condition and the effectiveness of treatment. With proper medical care and lifestyle modifications, many individuals can experience relief from symptoms and a reduced risk of recurrence.

Sources

Mayo Clinic. (2022). Pilonidal Cyst.
My Health Alberta, Canada: “Skin Cyst. Home Treatment.
NIH National Library of Medicine, Clinics in Colon and Rectal Surgery. Pilonidal Disease.
American Society of Colon & Rectal Surgeons. Pilonidal Disease.
Cleveland Clinic. Pilonidal Cyst, Sacral Dimple.
The University of Texas at Austin University Health Services. Pilonidal Cyst.
American Academy of Dermatology Association. (2022). Pilonidal cyst: Who gets and causes.