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Home :: Skin Disorders :: Pilonidal Cyst
Pilonidal Cyst
What is a Pilonidal Cyst?
A pilonidal cyst is a chronic infection of the skin near the buttocks. The most common place for a pilonidal cyst to develop is in the skin over the tailbone, just over the cleft in the buttocks. A pilonidal cyst is basically an abscess of pus and hair beneath the outer skin. A pilonidal cyst is nothing but a sac under the skin at the base of the spine. It looks like a small hole, often with a few hairs coming out.
Trauma or injury on the infected area may cause the pilonidal cyst to become very tender and painful, producing swelling and drainage. They generally occur in men, and normally happen in early adulthood. It can also occur in women - usually between puberty and age of 40. Persons who are excessively overweight or those with thick body hair are also more prone to pilonidal cysts.
Causes
Infection is usually caused by staphylococcal bacteria. If infected you may need an antibiotic to fight the infection. Your doctor may have to open the cyst to drain the pus, and may need to remove the cyst surgically.
The cysts form before birth, but present no problem until bacteria cause them to become infected.
A pilonidal cyst usually presents with pain. The cyst may be a small or a large painful mass. Often the area will drain some fluid which may have a foul odor. When a foul odor is detected an infection is usually present. An infection will also usually have surrounding red skin as well as exquisite tenderness when touched. Clear or bloody fluid may also exude from this are
Pilonidal cysts are usually caused by ingrown hair in the folds of the skin. Hair may become ingrown because of friction (rubbing) or irritation near the bottom of the spine. The friction causes hair to dig into the skin and get trapped there. Pilonidal cysts may become infected, and cause an abscess (AB-ses). An abscess is a localized collection of pus in a cavity or pocket.
Pilonidal cysts form before birth while the unborn baby is growing in the uterus (womb). Constant irritation, such as from tight clothing, may cause the hairs to get trapped and infected. The infection may be caused by a germ called a bacteria (bak-teer-e-uh) that enters the cyst.
Treatment
After the infection is cleared, a day surgery procedure to remove the cyst is performed. The cyst may be a simple abscess or may be draining from sinus tracts that need to be closed. The process of raising the borders of the emptied cyst and stitching them to form a pouch is called marsupialization.
The interior of the pouch then empties the collection of pus and gradually closes. Several weeks of packing the pouch with gauze is needed to collect the pus while the pouch closes. There are several treatments for pilonidal sinus, and some controversy over which is the best; none is well studied:
- Closed technique of Lord and Millar: core out the affected midline epithelial follicles and then brush the track weekly until closure to remove hairs. Healing takes an average of 42 days. Injecting the track with phenol instead of brushing gives similar results. Done under local.
- Open up the track and let it heal by secondary intention. Healing takes an average of 43 days. Average healing time is similar when cauterization with heat, silver nitrate, or freezing is added. Done under local.
- Wide and deep excision to the sacrum: done if one believes that the sinus is congenital. Average healing time is 73 days if the wound is left open, and 27 days if it is partially closed
- Excision with primary closure: requires general anesthesia. Healing occurred in 2 weeks in 90% of patients; the rest had been reopened and heal by secondary intention.
No care is needed if the cyst is not infected. If the cyst is infected it may need to be opened to drain the pus and to remove trapped hairs. The cyst may need to be removed if the infection does not get better or if it returns. You may need to take antibiotic (an-ti-bi-ah-tik) medicine to kill the medicine.
Treatment consists of surgical opening and draining of the infected sinus. The most commonly used surgical procedure is excision of the cyst, with either an open or closed wound for healing. Laser applied to pilonidal sinus surgery has been shown to reduce postoperative pain and swelling. In some cases the cyst can come back, even after surgery. The reasons for this are not known. When this happens, surgery can again be done, as an outpatient, with the exact nature of the procedure dictated by the nature of the recurrence.
pilonidal cysts can be surgically removed.
Treatment for a pilonidal cyst usually begins when the patient goes to the doctor because of pain. It is treated as an infection, and a doctor might prescribe antibiotics as well as the application of hot compresses. Often the cyst is lanced, and surgery is a method that has met with some success for curing pilonidal cysts. Surgery on a cyst in the tailbone area involves cutting out the skin and flesh all the way down to the coccyx and allowing the body to regrow the ablated tissue. Varying methods are used to either pack the wound, or suture it partially and even completely, depending on the physician's opinion on how best to treat the patient. The condition can recur, even after surgery. Some people have a chronic problem with this, while most others never have the condition again after surgical treatment.
Treatment of this problem is surgical. Initial therapy includes identification of the problem as well as antibiotic therapy if an infection is present. If an abscess (a collection of pus which is deeper in the tissues) is present an incision and drainage is required. This will assist resolution of the infection when antibiotics are also used.
he treatment depends on the symptoms. Minor cysts with no symptoms may need no therapy. There is no role for dietary therapy or restriction of daily activities. If a cyst is painful, soaking in a warm tub baths may help relieve the pain. An acute abscess is usually drained by making a small skin incision with a scalpel which releases the pus, reduces the pain, and allows healing. This procedure usually can be performed in the office with local anesthesia. Antibiotics are not the primary mode of treatment, but may supplement surgical drainage.
Unfortunately, 40% of patients return with recurrence of their disease after primary treatment. A chronic sinus or recurrent disease will need to be treated surgically. Depending on the situation, procedures vary. Sometimes the cyst is "unroofed" and the wound left open to heal. In this case, daily wound dressing or packing is needed to keep it clean to allow it to heal from the inside out. Although it may take up to two months to heal, the long-term success rate with open wounds is higher. A wide excision of the cyst and closing the wound with skin flaps is a bigger operation and has a higher chance of infection; however, it may be required in some patients. Your surgeon can best decide which is best.
You may need an antibiotic to fight the infection. Your doctor may have to open the cyst to drain the pus, and may need to remove the cyst surgically.
- If the cyst is not infected, keep the area clean and dry. Bathe or shower daily and wash the area well with a germ-killing soap. Taking hot tub baths helps prevent infection. Dry the area well with a towel.
- Avoid tight clothing.
- If the cyst is infected and needs to be cut open and drained, your doctor will pack the wound with gauze. This allows the wound to heal from the inside outwards. You should return to the doctor's office in a few days for a follow-up wound check.
- Do not take tub baths or showers until the gauze is removed. You may wash at the sink.
- After the gauze is removed, apply a warm, wet wash cloth to the area or sit in a tub of warm water for 15 to 20 minutes several times a day to relieve the pain. Then clean the wound gently with mild, unscented soap.
- If your doctor prescribes an antibiotic to fight the infection, take all of the medication exactly as directed, even if you are feeling better. If you stop treatment too soon, some bacteria may survive and re-infect you. If you are using a pain reliever, take it exactly as directed.
A pilonidal cyst will be treated with antibiotics if the area is infected. The cyst is usually opened and drained, and may need to be packed with gauze for several days to weeks. Sometimes the infected sinus may need to be surgically removed if the cysts recur or if your surgeon feels surgical treatment is necessary.
Soaking in a warm, soapy or medicated bath may help ease the pain and showering and cleansing the area may be prescribed. This will help clean out the infected area. Tylenol or Motrin/Advil in recommended doses may help with pain control also.
Keep pilonidal dimples clean and free of debris during regular bathing. Report any drainage of fluid from the dimple, either clear or containing pus, to your health care provider.
Signs and Symptoms
You may not see or feel anything when the cyst is not infected. Your skin may hurt and look red and swollen if the cyst fills with pus and becomes infected. You may have chills, a fever, or yellow or white drainage coming from the cyst. Fluid from the cyst may cause burning and itching.
Pilonidal disease often has no symptoms. If the cyst becomes infected, you may have redness or swelling near the top of the crease of your buttocks, cloudy fluid or blood draining from the cyst, and sometimes difficulty walking or sitting because of pain from the area of the cyst.
Symptoms vary from a small pimple to a large painful mass. Often the patient will notice fluid draining from the area and staining their underwear. Often, the wife sees her husband's stained shorts in the laundry basket and insists he see the doctor. If infection occurs, the area becomes red, tender, and the drainage (pus) will have a foul odor. An infected pilonidal cyst is called an acute abscess and can be very painful. These patients seek medical attention immediately complaining of a very tender spot right between the buttocks. The pain may be so bad that it may be difficult to sit or walk.
After an acute abscess resolves, either by itself or with treatment, patients may develop a sinus tract. A sinus tract is a cavity below the skin surface that connects to the surface with one or more small openings. Although a few of these sinus tracts may resolve without therapy, most patients need an operation to eliminate them. If repeated infections occur, surgery is almost always required to resolve this condition.
How is it diagnosed?
Pilonidal disease is diagnosed by your health professional after visually examining the area around the crease in the buttocks. No other tests are usually needed.
octors pilonidal cyst surgery images treatment for pilonidal cyst are not sure what causes a pilonidal cyst. One theory is that a small and harmless cyst has always been present at birth, and that for surgical removal of pilonidal cyst some reason, it has become irritated and formed a painful abscess. Another explanation is that it is an ingrown hair that has formed preventing pilonidal cyst an abscess. It is common to find hair follicles inside the cyst-according to some statistics approximately fifty percent pilonidal cyst pictures of the cysts drained are found to contain hair follicles, though this is not thought to be the sole cause of the condition.
It was discussed by Herbert Mayo in 1830. R.M. Hodges was the first to use the phrase "pilonidal cyst" to describe the condition in 1880. It is a combination of two Latin words, pilus, meaning pilonidal cyst surgery hair and nidal, meaning nest.
The condition was widespread in United States Army during World War II. More than eighty thousand soldiers pilonidal cyst image pilonidal cyst removal for babies had the condition requiring hospitalization. It was termed "Jeep riders' disease," because a large portion of people who were being hospitalized nursing research articles on pilonidal cyst for pilonidal cyst removal for enfants it rode in jeeps, and it was theorized that prolonged rides in the bumpy vehicles pilonidal cyst caused the condition.
There will be swelling and inflammation, and may be a discharge of pus.
Pilonidal Cysts usually form just to the side of the top crease in the buttocks. The sinus opening (if there is one) is typically in the center of the crease. The lump can be as small as a pea or larger than a golf ball. The lump moves slightly when you press on it - bone feels like bone and doesn't move. Usually the lump will hurt when you press on it - if it's infected it will hurt A LOT. If you have a sinus, it will typically drain a nasty smelling discharge that can be brownish, whitish, clear or streaked with blood. Some people don't get a "lump" if they have a draining sinus - the lump forms as infected fluid builds up inside the cyst.
Many people note lower back pain as problems with their cyst escalate. There is no known tie, but theories from the message board have suggested that the pressure from the cyst is crowding nerve endings heading to the spinal cord, most likely the sciatic nerve. It also have been suggested that most Pilonidal sufferers tend to "sit funny" to try and get comfortable. This throws the back out of normal alignment. Most people who have lower back pain have found that it disappears after the cyst is treated or removed.
Pilonidal disease is diagnosed by your health professional after visually examining the area around the crease in the buttocks. No other tests are usually needed.
Doctors are not sure what causes a pilonidal cyst . One theory is that a small and harmless cyst has always been present at birth, and that for some reason, it has become irritated and formed a painful abscess . Another explanation is that it is an ingrown hair that has formed an abscess. It is common to find hair follicles inside the cyst-according to some statistics approximately fifty percent of the cysts drained are found to contain hair follicles, though this is not thought to be the sole cause of the condition.
It was discussed by Herbert Mayo in 1830. R.M. Hodges was the first to use the phrase "pilonidal cyst" to describe the condition in 1880. It is a combination of two Latin words, pilus, meaning hair and nidal, meaning nest.
The condition was widespread in United States Army during World War II . More than eighty thousand soldiers had the condition requiring hospitalization. It was termed " Jeep riders' disease," because a large portion of people who were being hospitalized for it rode in jeeps, and it was theorized that prolonged rides in the bumpy vehicles caused the condition.
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