(Pilonidal Sinus; Pilonidal Abscess)
Pronounced: PIE-low-NIGH-dull sistEn Español (Spanish Version)
A pilonidal cyst is a fluid-filled defect. It is found at the base of the spine, or “tailbone” area.
The terms cyst, sinus, and abscess refer to different stages of the disease process.
- Cyst—not infected
- Abscess—pocket of pus
- Sinus—opening between a cyst (or other internal structure) and the outside
When a pilonidal cyst is infected, it forms an abscess, eventually draining pus through a sinus. Pilonidal cysts are harmless until they get infected. At this point they form an abscess that causes pain, a foul smell, and drainage. This is more likely to occur in young Caucasian men with a lot of hair in the region.
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A pilonidal condition may be congenital or acquired. If congenital, it probably began as a defect that existed when you were born. Sometime later, the defect allowed an infection to develop. If acquired, it may be the enlargement of a simple hair follicle infection or the result of a hair penetrating the skin and causing an infection.
The following factors increase your chance of developing a pilonidal abscess:
If you experience these symptoms, they are due to a pilonidal abscess that needs to be treated by your doctor:
- Painful swelling over your sacrum (just above your tailbone)
- A foul smell or pus draining from that area
Your doctor will ask about your symptoms and medical history, and perform a physical exam. You will be referred to a surgeon for treatment. There are no diagnostic tests required.
Talk with your doctor about the best treatment plan for you. The choice of treatment will depend on the extent of the condition and your general overall health. Treatment options include:
As with all localized infections under the skin, hot water soaks will draw out the infection. This will not completely cure the condition, but it will help.
Incision and Drainage
The abscess is sliced, the pus drained, and the wound is packed with sterile gauze. This helps it heal from the inside out. But this usually does not cure the problem because abnormal tissue remains.
To completely cure the condition, all affected tissue needs to be removed. This is a more extensive surgical procedure than simple incision and drainage. The surgical wound may be closed with sutures or left open to heal from the inside.
Laser Hair Removal
There are recent reports that laser hair removal in the area may be effective treatment for pilonidal cysts.
American Academy of Dermatology
The American Board of Dermatology, Inc.
BC Health Guide
Canadian Dermatology Association
Merck CMC Research. The Merck Manual. 17th ed. West Point, PA: Merck and Co; 1999.
Pilonidal disease. Palo Alto Medical Foundation website. Available at: http://www.pamf.org/health/healthinfo/index.cfm?page=article&sgml_id=ug1160. Updated January 13, 2006. Accessed June 15, 2008.
The pilonidal support alliance. Pilonidal Support Alliance website. Available at: http://www.pilonidal.org/. Updated May 24, 2008. Accessed June 15, 2008.
Sadick NS, Yee-Levin J. Laser and light treatments for pilonidal cysts. Cutis. 2006;78:125-128.
Last reviewed February 2008 by Ross Zeltser, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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