Pilonidal cysts typically develop above the cleft of the buttocks. They occur when pilonidal sinuses, small holes in the skin, become infected.

Pilonidal cysts can lead to significant discomfort if they become infected. These cysts develop when a pilonidal sinus fills with fluid, pus, and other debris. A pilonidal sinus is a small hole or indentation in the skin, and it does not require treatment itself.

Pilonidal cysts and sinuses are both parts of the broader term pilonidal disease.

In this article, we detail the causes and symptoms of pilonidal cysts and explain what a person can do to treat and prevent them.

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Pilonidal cysts are the result of an infection. What these cysts look like and the other symptoms that accompany them can differ among individuals.

Common symptoms of pilonidal cysts include:

  • pain alongside skin discoloration and swelling
  • pus or blood oozing from the cyst
  • an odor from the pus
  • pain when touched
  • a fever

At present, the exact reason why pilonidal cysts develop is unclear.

Pilonidal cysts are more common in males than in females. People are also most likely to develop pilonidal cysts between puberty and 40 years old.

An abundance of hair in the buttock region may also increase a person’s risk of developing the condition — the word “pilonidal” means “nest of hair.”

Another possible cause of a pilonidal cyst is the result of applying force or friction to the area.

A doctor can diagnose a pilonidal cyst by carrying out a physical exam and asking the person questions. These questions may include:

  • When did the symptoms first occur?
  • Has this problem happened before?
  • Have you had a fever?

The doctor will also assess the person’s family medical history.

A medical professional will typically treat all forms of pilonidal disease, including pilonidal cysts, through surgery.

Incision and drainage

A common treatment method for pilonidal cysts and abscesses is incision and drainage. In this procedure, a doctor will remove any hair or hair follicles from the cyst and drain any fluid. They will then pack the wound with gauze. The doctor may also choose to seal the area with stitches.

Marsupialization

Once they have incised and drained the cyst, a medical professional may sew the open edges together to form a small pouch. This marsupialization procedure allows fluid to drain easily from the area and can make cysts less likely to return.

Learn more about marsupialization procedures here.

Limberg flap

During a Limberg flap operation, a doctor will make a rhomboid-shaped incision over the sinus and remove all affected tissue from the area. They will then create an incision in the surrounding buttock area and pull a fold, or flap, of skin over the initial sinus site.

This procedure typically takes place under general anesthesia and is one of the most effective surgical interventions for pilonidal disease.

Karydakis flap

The Karydakis flap procedure involves surgically removing affected sinus tissue and creating a vertical incision to one side of the original opening. From this cut, the surgeon then pulls the skin over the original sinus area and sews it down.

Reviews have shown that the Karydakis flap procedure results in lower rates of pilonidal disease recurrence and complication than standard excision methods.

Standard excision methods typically remove the affected sinus but do not pull skin folds over the wound area for healing.

As with any form of surgery, it is important that people take note of all instructions relating to at-home care, especially if gauze needs removing and repacking.

General advice for recovery includes:

  • keeping the area clean
  • checking for signs of an infection
  • attending follow-up appointments

A pilonidal cyst may also cause complications, including the following:

  • development of an abscess
  • recurrence of the cyst
  • a systemic infection that spreads through the body

In rare instances, pilonidal disease can progress into squamous cell carcinoma, a type of cancer.

Generally, the outlook for anyone with a pilonidal cyst is excellent, with a complete cure being possible.

Maintaining good hygiene around the area at the base of the spine is important. This helps prevent the development of pilonidal disease, as well as its recurrence if it does occur.

Steps that people can take to reduce the risk of pilonidal cysts developing include:

  • keeping the area clean and dry
  • keeping the area free of hair by shaving or using depilatory creams
  • avoiding sitting for a long time

People who are overweight may also find that weight loss reduces the risk of cysts developing or recurring.

Pilonidal cysts occur when a pilonidal sinus, a small hole or indentation in the skin, becomes infected. This typically happens when hair or other debris fills the sinus. Pilonidal cysts tend to occur on a person’s lower back, just above the cleft of the buttocks.

A person with a pilonidal cyst may experience swelling, pain, and skin discoloration in the affected area. A doctor will typically treat pilonidal cysts with minor surgical procedures. They can perform these under local or general anesthetic.

The outlook for a person with pilonidal cysts is usually positive. Surgical treatment generally allows a person to return to their day-to-day life with little impediment.

People can help prevent pilonidal cysts by keeping the area around their buttocks clean and dry. Removing body hair through shaving or creams can also help.