This condition normally occurs in the anorectal region and typically presents in any one of the following ways:

• Acute abscess
• Sinus tracts
• Chronic and recurrent abscess with extensive branching tracts.

Usually, the cyst is asymptomatic; unless it becomes infected and there is complaint of foul smelling discharge along with severe pain and redness at the bottom of the spine. Even at the height of inflammatory symptoms, constitutional symptoms are mild. As the acute abscess resolves, chronic sinus tracts develop towards the skin [5].

If there is a chronic recurring sinus, it is commonly in the midline, about the level of the first piece of coccyx. There is a tuft of hair projecting from the mouth of the sinus. Discharge is often blood stained, and foul smelling from the sinuses. Secondary openings may be present on either side of the midline, sometimes far out onto the buttocks or in the perineum. A sinus can have has many as six openings. Chronic or recurrent abscesses with extensive branching tracts develop in few cases.

Most of the openings occur about 4-8cm away from the anal opening. Unlike a fistula in ano, the sinus passes upwards and forwards towards the sacrum and ends blindly near the bone [6].

• Pain

  A pilonidal cyst is usually painful, but with draining, the patient might not feel pain. [en.wikipedia.org]

  Patients with painful, infected sores may also be advised to take over-the-counter nonsteroidal anti-inflammatory medications like acetaminophen or ibuprofen to help ease the pain, according to the University of Michigan Health System. [livestrong.com]

  Symptoms include pain, redness, and pus leakage at the bottom of the spine, and fevers may result in serious cases of infection. [procedureclinic.com]

  If your child has had multiple infections or considerable pain, surgery is an effective way to relieve pilonidal cyst pain and prevent the spread of infection. [chop.edu]

• Swelling

  The symptoms experienced by someone with a pilonidal cyst include the following: Pain at the bottom of the spine Swelling at the bottom of the spine Redness at the bottom of the spine Draining pus Fever A pilonidal cyst is an abscess or boil. [utcolorectal.org]

  Occasionally, pus accumulates in the cyst, causing pain and swelling in the tailbone area to form (abscess). When this occurs, a patient will experience a fever and sometimes acute pain and swelling in the tailbone area. [colonrectal.org]

  If symptoms occur, they may include: Swelling Irritation or redness Pain Drainage The cyst can swell and drain on its own. The swelling and drainage can come and go. [fairview.org]

• Fever

  The symptoms experienced by someone with a pilonidal cyst include the following: Pain at the bottom of the spine Swelling at the bottom of the spine Redness at the bottom of the spine Draining pus Fever A pilonidal cyst is an abscess or boil. [utcolorectal.org]

  Symptoms include pain, redness, and pus leakage at the bottom of the spine, and fevers may result in serious cases of infection. [procedureclinic.com]

  Share on Pinterest A pilonidal cyst develops in the cleft between the buttocks and may cause pain and a fever. [medicalnewstoday.com]

• Inflammation

  By eliminating the area where hair follicles can get blocked and cause inflammation and infection, most patients can avoid having further complications of pilonidal disease. [luriechildrens.org]

  May be lined by squamous epithelium with inflammation +/- pseudoepitheliomatous hyperplasia. Neutrophils. Granulomatous inflammation. DDx: Squamous cell carcinoma of the skin with inflammation. [3] Infection. Hidradenitis suppurativa. [librepathology.org]

  If coarse hair becomes embedded in an interdigital fold, it may lead to chronic inflammation, the formation of a sinus tract, and chronic, purulent drainage. [nejm.org]

  Clinical science Summary 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. [amboss.com]

• Surgical Procedure

  Several surgical procedures are described in literature. The most common surgical procedure in Sweden is excision of the sinus followed by suturing the subcutaneous tissue and skin. [clinicaltrials.gov]

  The Mayo Clinic notes that, compared with the closed-wound surgical procedure, this approach poses less risk of recurring infection; however, healing generally takes significantly longer and the sterile dressings require regular changing to keep the area [livestrong.com]

  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. [uvahealth.com]

• Overeating

  The wrinkled skin present over eyelids could have contributed to the penetration of hair. [ijdvl.com]

  A pilonidal cyst is a cavity underneath the skin over the tailbone. Pilonidal literally means “nest of hair” because the cavity is often found to contain hair. [colonrectal.org]

  Thanks, About The Author Randy Herring Randy Herring is a certified personal trainer with over 20 years experience. [bodybuilding.com]

  Patients with painful, infected sores may also be advised to take over-the-counter nonsteroidal anti-inflammatory medications like acetaminophen or ibuprofen to help ease the pain, according to the University of Michigan Health System. [livestrong.com]

• Constipation

  It causes constipation (bad). I had no bowel movement for 48 hours and that concerned me. (I admittedly was scared to "squat down" due to the thought of re-opening the wound and splitting it!) My doctor recommended I take a laxative. [bodybuilding.com]

  WHAT IS CONSTIPATION Constipation, a common complaint, is usually simple to prevent and easy to treat when it occurs. [fascrs.org]

  Will I become constipated? Not as a result of the procedure. But – taking a narcotic can definitely lead to constipation, and the prescribed stool softener should be taken regularly. [pilonidalsurgery.com]

• Diarrhea

  The amount of fluid expulsion, i.e., diarrhea! This raised my fear of infecting the wound from the diarrhea splashing back up (bad)! [bodybuilding.com]

• Tachycardia

  61 Sonawane GB...Pillai BS 31619872 2019 31 Successful cryoballoon ablation of a focal atrial tachycardia in a patient with situs inversus and dextrocardia. 61 Akkaya E...Erkapic D 31624605 2019 32 Optical coherence tomography angiography in situs inversus [malacards.org]

• Hirsutism

  Men are at a higher risk because of their hirsute nature. The age of incidence of appearance of pilonidal cyst is between early puberty till late twenties. It is very rare above 45 years of age. [symptoma.com]

  Pilonidal disease usually occurs in young, hirsute, white males but can also occur in women. One or several midline or adjacent-to-the-midline pits or sinuses occur in the skin of the sacral region and may form a cavity, often containing hair. [merckmanuals.com]

  […] discharge from the umbilicus • skin lesions • pruritis Medication: — Clinical Procedure: Umbilicus preserving surgery Specialty: General Surgery • Dermatology • Plastic Surgery Background: Umbilical pilonidal sinus (UPS) is a rare disease of young, hirsute [ncbi.nlm.nih.gov]

  Males are affected more frequently than females, probably due to their more hirsute nature. In a population study of 50,000 students the incidence in males was 1.1%, ten times more than in females, although many of these were asymptomatic. [advancedreconstruction.com]

• Dermatitis

  Stay up to date with recent society guidelines, including the latest from the American Academy of Dermatology, covering a variety of conditions such as melanoma and atopic dermatitis. [books.google.ca]

  2 Elif Tugce Kaplan, B, C, E, F, 3 Tugba Kaplan, B, C, E, F, 4 and Fatma Cigdem Kaplan A, E, 5 Abstract Case series Patient: Male, 26 • Female, 21 Final Diagnosis: Umbilical pilonidal sinus Symptoms: Hair tuft in the umbilicus • pain • periumbilical dermatitis [ncbi.nlm.nih.gov]

  ) Diseases of the skin and subcutaneous tissue L00-L08 2019 ICD-10-CM Range L00-L08 Infections of the skin and subcutaneous tissue Type 2 Excludes hordeolum ( H00.0 ) infective dermatitis ( L30.3 ) local infections of skin classified in Chapter 1 lupus [icd10data.com]

• Erythema

  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. [amboss.com]

  The male patient had seropurulent discharge, a small sinus opening coated with granulation tissue with a tuft of hair protruding deep in the umbilicus, forming a “nest of hair”, periumbilical dermatitis with erythema, and soiling from the umbilicus [ncbi.nlm.nih.gov]

  […] sign of Leser-Trelat ) atrophic ( Lichen sclerosus, Acrodermatitis chronica atrophicans ) necrobiosis ( Granuloma annulare, Necrobiosis lipoidica )· other granuloma ( Granuloma faciale, Pyogenic granuloma ) cutaneous vasculitis ( Livedoid vasculitis, Erythema [helpebookhindi.wikifoundry.com]

• Acne Vulgaris

  This is seen for example in acne vulgaris (teen pimples). However, other conditions can also start with the changes in the sex hormone levels in the body. [healthhype.com]

• Eczema

  This works well because it helps treat some skin condition, such as eczema or psoriasis. When it comes to pilonidal cysts treatment, the root assists in eliminating the toxins, hence, healing your cyst. [authorityremedies.com]

  KUSTHA  ARBUDA  BHAGANDARA  ARSAS  VAATRAKTA  SANDHI ASTHI MAJJA GATA VAATA  CERVICAL SPONDYLOSIS  LUMBAR SPONDYLOSIS  PSORIATIC ARTHROPATHY  GOUTY ARTHRITIS  PAGETS DISEASE  OA  OSTEOPOROSIS  DRY AND CRACKED SKIN  AVN  PSORIASIS  DRY ECZEMA [slideshare.net]

• Hunger

  By JEN GUNTER Well Photo Credit Illustration by Celia Jacobs Outrunning Hunger Intense exercise may change the way certain neurons influence our appetite and metabolism. [nytimes.com]

• Kidney Failure

  Tumors of the lung and oral cavity, probably related to the high level of smoking among these patients, and liver cancer.[44] Hypoproteinemia and amyloidosis, which can lead to kidney failure and death[45] Seronegative and usually asymmetric arthropathy [en.wikipedia.org]

• Irritability

  Injury, rubbing, or skin irritation may also cause pilonidal cysts. It can also be caused by an ingrown hair. The cause is most likely a combination of these things. [fairview.org]

  Injury, rubbing, or skin irritation may also cause pilonidal cysts. It can also be caused by an ingrown hair. Most likely, the cause is a combination of these things. [mountnittany.org]

• Dizziness

  Do contact your physician if you notice any of the following symptoms: Worsening pain and swelling of the surgical wound Bleeding or fluid drainage from the surgical wound Signs of an infection Headache, muscle aches Fever, feeling sick Dizziness Complications [dovemed.com]

• Forgetful

  Don’t forget to keep your affected area clean. To clean it, wash it off with water for about three times per day. [authorityremedies.com]

Pilonidal cysts require no laboratory tests or imaging techniques. Simple clinical examination is enough for a diagnosis. Clinically, the physician will see a tender cystic swelling above the buttock, which will show all the signs of inflammation. There may be many openings to the cyst. Due to the inflammation, the surrounding skin may show slight cellulitis. It appears like a small cystic acne at the bottom of the spine. Pilonidal cysts cause severe pain if infected.

Treatment depends on the presentation of the case. Ideally, the treatment selected should be a simple procedure with minimum morbidity and faster recovery and healing.

Patients reporting for the first time with mild symptoms can sometimes be treated by conservative measures which include, cleaning of the tract, and removal of the hair from the affected area followed by frequent washing of the affected area. Good personal hygiene is a must.

Incase of an acute abscess, if the above conservative measures fail to bring about resolution of the abscess, the abscess should be opened by a small incision. All the granulation tissue, skin debris and hair should be removed. After complete cleaning of the tract, there is some prospect of curing the lesion. Sometimes post cleaning, phenol is injected into the tract to produce sclerosis of the tract. Wound care has to be done by washing the wound with warm water or Sitz bath. Skin will eventually heal and close provided the area is kept clean and free of hair. In a majority of cases, complete wound heals in one month [7].

For patients with recurrent and persistent pilonidal disease a more invasive form of surgery will be required. Procedures vary from unroofing the sinus tract to excision to possible closure with flaps. In general the difference in surgical techniques involves leaving the wound open after surgery to allow it to heal versus closure of wound during surgery [8].

Marsupialization [9] is another surgical technique that might be done where a slit is made on the abscess and the edges are sutured to form a contionus surface from outside to inside of the cyst, thus allowing the site to remain open and drain freely. Proper wound care and hygiene should be maintained post-surgery to prevent recurrence.

The prognosis in most cases of pilonidal cyst is excellent. Wound healing can be delayed or can get infected. Recurrence occurs in 50% cases.

A pilonidal cyst was considered to be congenital or inborn in nature, where a small depression forms above the buttocks. The origin was considered embryonic [2]. This postulate does not account for pilonidal cyst which occurs in other areas.

Currently, the most accepted theory regarding the etiology and origin is that of an ingrown hair or hair broken by friction against clothes or weight, which collects in the cleft between the buttocks. This hair shaft tends to invade the deeper layers of the skin. As a response to the hair as a foreign body, the body produces an inflammatory reaction. This leads to a hair filled abscess cavity.

Excessive pressure, friction and repeated trauma to the area facilitate entry of the hair shaft in to the layers of the skin.
Risk factors associated with this condition are obese and hirsute individuals. Inactive and prolonged periods of sitting can aggravate this cyst. Poor hygiene may increase the risk.

Pilonidal diseases affect about 26 cases per 100,000 people. There is a male preponderance, where males with this condition outnumber females by a ratio of 4:1. Men are at a higher risk because of their hirsute nature [3].

The age of incidence of appearance of pilonidal cyst is between early puberty till late twenties. It is very rare above 45 years of age.

The main theory regarded by many is the penetration of the hair shaft into the subcutaneous layers of the skin. Follicular occlusion is considered the main cause. Folliculitis causes oedema which occludes the hair follicle; thus the hair follicle penetrates through the dilated hair follicle. A sinus tract develops which extends into the subcutaneous layers. A foreign body reaction leads to the formation of an abscess. Additional sinuses are common.

Histological sections show a dense inflammatory reaction in the dermis as well as epidermis. Along with inflammation there may be ulceration which can lead to erosion of the layers of the skin.

Histologically, the sinus tract is line by stratified squamous epithelium. Hair shafts are either found loose in the sinus or deeply embedded in the scar tissue. The etiology of foreign body reaction is supported by histology [4].

Cyst is lined with chronic granulation tissue and may contain hair and skin debris. Polymorphs infiltrating the wound may range from plasma cells to lymphocytes. Foreign body giant cells are common.

Proper hygiene should be maintained to prevent reappearance of pilonidal cyst. The area should be kept clean and dry and hair should be removed. Weight management is important.

A pilonidal cyst is a localised, fluid-filled swelling which almost always occurs along the coccyx near the natal cleft of the buttocks. The main contents of the cyst are hair shafts and skin debris. Hair penetrates into the deeper layers of the skin. Most of these cysts are asymptomatic, unless they become infected resulting in abscess and sinus formation. This results in severe pain and tenderness.

Pilonidal diseases include the entire spectrum of clinical presentation ranging from an asymptomatic cyst and sinus to a large painful abscess mainly of the sacrococcygeal region. Other lesser common sites of pilonidal cyst are axilla, navel and genitalia [1].

These cysts require surgical intervention, though chances of reoccurrence are common.

Pilonidal cyst is a small swelling that occurs at the bottom of the spine, in the cleft at the top of the buttocks. It causes severe pain if it becomes infected which results in severe foul smelling discharge. It may initially appear as a depression; once it gets infected it appears like a pimple.

It occurs more in men and rarely happens as age progresses. The exact origin is not known and is said to be mainly due to combination of various factors of excessive hair growth, pressure and prolonged sitting.

Pilonidal cyst may not be noticeable at first and will simply look like a pimple like depression, however once infection sets in, a fluid-filled swelling will be formed. There will be severe pain, redness and discharge which may be blood stained may ooze. A sinus tract will follow with many openings on the surface of the skin. These sinuses tend to appear repeatedly.

A medical health provider can easily diagnose the condition by a simple physical examination. Treatment depends on the severity, in case there is no symptoms conservative treatment in form of broad spectrum antibiotics is given. If severe infection is present along with pain, a small incision along with drainage is done. This is a simple and less invasive procedure.

Recurrent pilonidal sinuses require a surgery which mainly excises the entire cyst with the sinus tract. Post operative care is very important, to enable the wound to heal faster. Usually, a pilonidal cyst clears within 4-10 weeks.

Preventive measures in form of personal hygiene, hair removal and weight loss are recommended. Pilonidal cyst have very good recovery rate with correct medical care and preventive care.

1. Rao AR, Sharma M, Thyveetil M, Karim OM. Penis: An Unusual Site for Pilonidal Sinus. Int Urol Nephrol. 2006;38(3-4):607-8. 
2. da Silva JH. Pilonidal cyst: cause and treatment. Dis Colon Rectum. 2000 Aug;43(8): 1146–56.
3. Hodges RM. Pilonidal sinus. The Boston Medical and Surgical Journal. 1880, 103: 485–586.
4. Klass A. The So-Called Pilo-Nidal Sinus. Canadian Medical Association. 1956 Nov 1;75(9): 737–742.
5. Timmons J. Diagnosis, treatment and nursing management of patients with pilonidal sinus disease. Nursing Standard. 2007 Sep 5;21(52):48-56; quiz 58.
6. Abramson DJ. Outpatient Management of Pilonidal Sinuses: Excision and semiprimary closure technic. Mi Med. 1978 Nov; 143 (11): 753–7.
7. Bascom J, Bascom T. Failed Pilonidal Surgery. Arch Surg. 2002 Oct;137 (10): 1146–50.
8. McCallum IJD, King PM, Bruce J. Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis. Br Med J. 2008;336:868-71.
9. Roth RF, Moorman WL. Treatment of pilonidal sinus and cyst by conservative excision and W-plasty closure. Plast Reconstr Surg. 1977 Sep;60(3):412–15.