Pilonidal means “nest of hair”, and is derived from the Latin words for hair (“pilus”) and nest (“nidus”). The term was used byHerbert Mayo as early as 1830.R.M. Hodges was the first to use the phrase “pilonidal cyst” to describe the condition in 1880. A pilonidal cyst is a pocket of tissue containing hair and skin debris that appears at the top of the buttock cleft near the tailbone. Although the origin is not fully understood, it is believed that these cysts are caused by hair becoming embedded in skin. The body reacts to the hair as a foreign object, enveloping it in tissue and developing a cyst.
Presentation of a Pilonidal Cyst
Pilonidal cysts can be painful, afflict men more frequently than women, and typically occur between the ages of 15 and 24. Although usually found near the tailbone, the condition can also affect the navel, armpit or penis, though these locations are much more rare.
A sinus tract, or small channel, may originate from the source of infection and open to the surface of the skin. Material from the cyst may drain through the pilonidal sinus. A pilonidal cyst is usually painful, but with draining, the patient might not feel pain.
Causes of Pilonidal Cysts and Sinuses
One proposed cause of pilonidal cysts is ingrown hair. Excessive sitting is thought to predispose people to the condition because they increase pressure on the coccyx region. Trauma is not believed to cause a pilonidal cyst; however, such an event may inflame an existing cyst. However there are cases where this can occur months after a localized injury to the area. Some researchers have proposed that pilonidal cysts may be the result of a congenital pilonidal dimple. Excessive sweating can also contribute to the cause of a pilonidal cyst.
The condition was widespread in the United States Army during World War II. More than eighty thousand soldiers having the condition required hospitalization. It was termed “Jeep riders’ disease,” because a large portion of people who were being hospitalized for it rode in jeeps, and prolonged rides in the bumpy vehicles were believed to have caused the condition due to irritation and pressure on the tailbone.
Treatment for Pilonidal Cysts
Treatment may include antibiotic therapy, hot compresses and application of depilatory creams.
In more severe cases, the cyst may need to be lanced or surgically excised (along with pilonidal sinus tracts). Post-surgical wound packing may be necessary, and packing typically must be replaced twice daily for 4 to 8 weeks. In some cases, 1 year may be required for complete granulation to occur. Sometimes the cyst is resolved via surgical marsupialisation.
Surgeons can also excise the sinus and repair with a reconstructive flap technique, which is done under general anesthetic. This approach is mainly used for complicated or recurring pilonidal disease, leaves little scar tissue and flattens the region between the buttocks, reducing the risk of recurrence.
The condition has a 4-8% chance of recurrence, even after surgery. Recurrence is greater if the surgical wound is sutured in the midline, as opposed to away from the midline, which obliterates the natal cleft and removes the focus of shearing stress.
There are also some simple preventative steps that can be taken in order to reduce the chance of developing pilonidal cysts. Practicing good hygiene can prevent loose hairs from accumulating and becoming embedded in the skin. For people who are overweight or obese, losing excess weight can be very helpful. Weight loss programs involving regular exercise not only reduce the amount of time spent sitting in the same position, but also decrease the depth of the buttock cleft as weight is lost.
If you would like to schedule an appointment with one of our physicians at the Texas Center for Obesity Surgery in Plano, please complete an online appointment request or call our office at 214-501-1333.