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Pilonidal cyst

Last updated: October 4, 2019

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A pilonidal cyst (intergluteal pilonidal disease) is a skin condition caused by local inflammation of the superior midline gluteal cleft, which may progress to a local abscess or fistula. It is currently hypothesized to be an acquired condition with local penetration of hair follicles and debris in stretched intergluteal pores. Affected individuals – typically obese, sedentary men with excessive body hair and a deep gluteal cleft – may be asymptomatic or present with mild local symptoms such as local oozing or erythema; however, abscesses can also cause severe pain. Pilonidal cysts are diagnosed based on patient history and clinical examination. To treat the condition, radical resection with secondary wound healing is usually necessary. Asymptomatic patients can be treated conservatively.

References:[1][2]

Epidemiological data refers to the US, unless otherwise specified.

The exact mechanism is unknown, however, the current prevailing hypothesis is that pilonidal disease is an acquired condition.

  • Sitting or bending cause hair follicles, in vulnerable skin within a deep natal cleft, to stretch and break → formation of an open pore or pit. These open pores either collect debris or broken hair roots (from the head, back or buttocks).
  • Movement causes negative pressure (e.g., “suction effect”) and further penetration of hair into local subcutaneous tissue → formation of a pilonidal sinus
  • These collections trigger local tissue inflammation within the pilonidal sinus → acute infection (abscess) or fistulae

References:[1][3][4][5][6][7]

  • Young men with excessive body hair
  • Obesity
  • Deep gluteal cleft
  • Poor anal hygiene/local irritation
  • Sedentary lifestyle
  • Family history

References:[7][8]

References:[1][4]

References:[4]

The differential diagnoses listed here are not exhaustive.

Conservative treatment

  • Indications
    • Asymptomatic patients
    • Postsurgical care of symptomatic patients
  • Approach
    • Improved local hygiene
    • Local hair control (e.g., laser epilation)
    • Observation for signs of infection

Surgical treatment

References:[4][7][9][10][11][12]

  1. Koyfman A, Long BJ, Shlamovitz GZ. Pilonidal Cyst and Sinus. Pilonidal Cyst and Sinus. New York, NY: WebMD. http://emedicine.medscape.com/article/788127-overview#a4. Updated: March 23, 2016. Accessed: December 6, 2016.
  2. Sullivan DJ, Brooks DC, Breen E, Berman RS, Chen W. Intergluteal pilonidal disease: Clinical manifestations and diagnosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/intergluteal-pilonidal-disease-clinical-manifestations-and-diagnosis?source=preview&search=%2Fcontents%2Fsearch&anchor=H31072511#H31072511.Last updated: March 4, 2015. Accessed: December 6, 2016.
  3. Majeski J, Stroud J. Sacrococcygeal Pilonidal Disease. International Surgery. 2011; 96 : p.144-147. doi: 10.9738/1393.1 . | Open in Read by QxMD
  4. Bailey HR, Billingham RP, Stamos MJ, Snyder MJ. Colorectal surgery. Elsevier Saunders ; 2012 : p. 170
  5. Goel TC, Goel A. Practical Surgery Short Clinical Cases. Jaypee Brothers Medical Publishers ; 2015 : p. 219
  6. Pilonidal sinus disease. http://www.worldwidewounds.com/2003/december/Miller/Pilonidal-Sinus.html. Updated: December 1, 2003. Accessed: December 6, 2016.
  7. Riojas RA, Layton BD, Schraga ED. Pilonidal Cystectomy. Pilonidal Cystectomy. New York, NY: WebMD. http://emedicine.medscape.com/article/1830066-overview#showall. Updated: October 5, 2015. Accessed: December 6, 2016.
  8. Ghnnam WM, Hafez DM. Laser Hair Removal as Adjunct to Surgery for Pilonidal Sinus: Our Initial Experience. J Cutan Aesthet Surg. 2011; 4 (3): p.192-195. doi: 10.4103/0974-2077.91251 . | Open in Read by QxMD
  9. Sullivan DJ, Brooks DC, Breen E, Berman RS, Weiser M, Chen W. Management of intergluteal pilonidal disease. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/management-of-intergluteal-pilonidal-disease.Last updated: June 21, 2016. Accessed: December 6, 2016.
  10. Greenberg R, Kashtan H, Skornik Y, Werbin N. Treatment of pilonidal sinus disease using fibrin glue as a sealant. Techniques in Coloproctology. 2004; 8 (2).
  11. Steele SR, Perry WB, Mills S, Buie WD. Practice Parameters for the Management of Pilonidal Disease. Dis Colon Rectum. 2013; 59 (9): p.1021-1027. doi: 10.1097/DCR.0b013e31829d2616 . | Open in Read by QxMD
  12. Rice PL, Orgill DP. Classification of burns. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/classification-of-burns?source=search_result&search=Burns&selectedTitle=2~150.Last updated: August 11, 2016. Accessed: December 12, 2016.