Pilonidal Cyst
Information on the causes, symptoms, and treatment of the hair follicle cyst appearing in the sacrococcygeal region.
Symptoms and causes
The pilonidal sinus is a cyst that forms in a hair follicle and contains hair and skin remnants. It usually appears in the intergluteal fold, which is why it is also referred to as a sacral cyst, but it may also occur in other locations. If it appears in the perianal area, it is more dangerous, as complications can involve the anus.
In most cases, these cysts are asymptomatic and do not cause problems; therefore, they are often not detected. Symptoms appear when the sinus becomes infected and develops an abscess (pus accumulation).
The pilonidal cyst is more frequent in young males with abundant body hair, although it can also affect females.
The prognosis of a pilonidal sinus is good, although surgical intervention is required to treat infected cysts.
Symptoms
Sacral cysts are usually asymptomatic, as previously mentioned. When infection occurs and symptoms develop, the most common are:
- Pain
- Skin redness
- Abscess with pus discharge
- Foul odor (caused by pus)
- Blood exudate
- Occasionally, fever
Causes
The exact causes of pilonidal cyst formation are still unknown. Until recently, it was believed to result from inward growth of a hair follicle. Currently, a congenital factor is suspected. It may represent an embryonic remnant in which hair grows from adolescence onwards due to hormonal influence.
Risk Factors
Factors that increase the risk of developing a pilonidal cyst include:
- Sex: more frequent in males
- Age: typically develops during adolescence with hormonal changes
- Prolonged sitting
- Sedentary lifestyle
- Obesity
- Thick and abundant body hair
- Family and personal history
Complications
The most common complications of the pilonidal sinus are:
- Recurrence: the cyst reappears after surgical removal
- Fistulas: pus spreads and forms an abnormal channel connecting the cyst to the skin surface
- Rarely, it may develop into squamous cell carcinoma, a type of skin cancer
Prevention
The sacral cyst cannot always be prevented. To reduce the likelihood of recurrence, especially if previous episodes occurred, it is recommended to:
- Exercise regularly
- Maintain a healthy weight
- Keep the area clean
- Shave or remove hair from the sacrococcygeal region
Which physician treats the pilonidal sinus?
Treatment of the sacral cyst is managed by specialists in General and digestive system surgery.
Diagnosis
Diagnosis of the pilonidal cyst is clinical and based on patient-reported symptoms and physical examination. Asymptomatic cysts are often detected incidentally during tests for other reasons.
When treatment is necessary, an Ultrasound or Computed Tomography (CT) Scan is typically performed to determine the cyst’s extent.
Treatment
Only infected and symptomatic pilonidal cysts require treatment. The only way to eliminate them is through surgery. The procedure is selected based on the patient’s characteristics and the surgeon’s preference:
- Surgical drainage: an incision is made to remove pus and trapped hair. The wound may be packed with gauze to heal naturally over 20–30 days or closed with stitches. The latter requires careful monitoring due to higher infection risk.
- Laser cauterization: a less invasive procedure with faster recovery. A probe is inserted into the sinus tract, and laser energy is applied to burn and seal the tissue. Recovery typically takes 2–4 weeks.
Postoperative care requires patience and proper wound management, keeping it clean and dry. Pressure on the area should be avoided, so sitting for prolonged periods and strenuous activity should be limited. Loose clothing and a high-fiber diet are recommended to prevent constipation.
Antibiotics are usually administered before surgery to treat infection and sometimes postoperatively to aid recovery and prevent complications.
As noted earlier, surgical removal of a pilonidal cyst is not always definitive. Many patients may redevelop the cyst over time.
