Pilonidal Cyst Disease

What is pilonidal cyst disease?

Pilonidal disease is a common condition of the skin and subcutaneous tissue at or near the upper part of the natal cleft of the buttocks which causes a chronic infection of the skin in the region of the buttock crease. It results from a reaction to hairs embedded in the skin. Excessive sitting is thought to predispose people to the condition, as sitting increases pressure on the coccygeal region. Other theories have been 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. Management is variable and guided by the clinical presentation and extent of disease. It is a chronic condition caused when hair and debris become lodged in a small opening or “pit” in the area near the tailbone. The area becomes inflamed and tracts are created that can cause a “sinus”. Hair and bacteria enter the tract causing an infection or abscess. The disease tends to be more common in patients who are overweight and those who have thick, coarse body hair. 

Risk factors for pilonidal disease

  • overweight/obesity
  • local trauma or irritation
  • sedentary lifestyle or prolonged sitting
  • deep natal cleft
  • increased hair density in the natal cleft region
  • family history

Symptoms

The symptoms of pilonidal disease can vary from a small dimple to a large painful swelling or mass. Often, the area will drain fluid that may be clear, cloudy or bloody. With infection, the area becomes red, tender and the drainage (pus) will have a foul odor. The infection can also cause fever, malaise or nausea. 

How do I know if my child has pilonidal disease?

  • pain at the tailbone
  • swelling
  • redness
  • drainage of pus or blood
  • fever

Treatment options/prevention

What if surgery is needed?

Treatment options depend on the disease pattern and extent of the disease. Most cases of pilonidal disease can be managed without surgery. If an infection is present, your child will need to take oral antibiotics. If your child develops an abscess, the area will need to be opened surgically to drain the pus. Surgery is reserved in patients with recurrent or complex disease after a trial of conservative management has failed due to the risk of recurrence and wound complications. 

  • incision and drainage (Opening up the area to drain the pus).
  • removing the “pits”
  • removing a “chronic sinus”
  • removing infected tissue from the area and then closing it with stitches or leaving it open to heal from the inside out
  • flap procedures are reserved for severe cases that do not respond to the treatments above 

Non-surgical treatments

Hair must be removed from the tailbone area on a frequent basis to prevent flare ups and recurrence. 

  • shave a 2-4 inch border around the area with an electric razor or beard trimmer
  • pluck any hair that is left with tweezers as well as remove hair from any of the sinus pits/openings
  • you may use hair removal products (NAIR or VEET)
  • consider hair removal if you are very hairy
  • make sure to check the area often 

How to prevent flare ups

  • close attention to personal hygiene with daily to twice daily baths/showers
  • continue frequent hair removal
  • wear loose fitting clothing/cotton underwear
  • remove damp clothing promptly (after gym, working out, sports and swimming)
  • limit activities that cause impact to the tail bone
  • keep your weight in the normal range 


Contact us

Our office is open Monday through Friday from 8:00 a.m. - 5:00 p.m. Call us with any questions or concerns in regards to your child's care or post-operative care. Our office number is 248-551-2400. After office hours and on weekends or holidays, your call will be directed to our on call surgeon thru our answering service.