Pilonidal cyst
Encyclopedia
A pilonidal cyst, also referred to as a pilonidal abscess, pilonidal sinus or sacrococcygeal fistula, is a cyst
or abscess
near or on the natal cleft of the buttocks that often contains hair and skin debris.
, the condition can also affect the navel
, armpit or penis
, though these locations are much more rare.
Some people with a pilonidal cyst will be asymptomatic
.
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.
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 result in inflammation of 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 sweat
ing 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 seat or "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 coccyx.
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, one year may be required for complete granulation
to occur. Sometimes the cyst is resolved via surgical marsupialization
.
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.
A novel and less destructive treatment is scraping the tract out and filling it with fibrin glue
. This has the advantage of causing much less pain than traditional surgical treatments and allowing return to normal activities after 1–2 days in most cases.
Pilonidal cysts recur and do so more frequently 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.
, a kind of teratoma
(germ cell tumor
). In particular, a pilonidal cyst in the gluteal cleft
can resemble a sacrococcygeal teratoma
. Correct diagnosis is important because all teratoma
s require complete surgical excision, if possible without any spillage, and consultation with an oncologist.
Cyst
A cyst is a closed sac, having a distinct membrane and division on the nearby tissue. It may contain air, fluids, or semi-solid material. A collection of pus is called an abscess, not a cyst. Once formed, a cyst could go away on its own or may have to be removed through surgery.- Locations :* Acne...
or abscess
Abscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...
near or on the natal cleft of the buttocks that often contains hair and skin debris.
Etymology
Pilonidal means "nest of hair", and is derived from the Latin words for hair ("pilus") and nest ("nidus"). The term was used by Herbert Mayo as early as 1830. R.M. Hodges was the first to use the phrase "pilonidal cyst" to describe the condition in 1880.Signs and symptoms
Pilonidal cysts are often very painful, affect men more frequently than women, and typically occur between the ages of 15 and 24. Although usually found near the coccyxCoccyx
The coccyx , commonly referred to as the tailbone, is the final segment of the vertebral column. Comprising three to five separate or fused vertebrae below the sacrum, it is attached to the sacrum by a fibrocartilaginous joint, the sacrococcygeal symphysis, which permits limited movement between...
, the condition can also affect the navel
Navel
The navel is a scar on the abdomen caused when the umbilical cord is removed from a newborn baby...
, armpit or penis
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...
, though these locations are much more rare.
Some people with a pilonidal cyst will be asymptomatic
Asymptomatic
In medicine, a disease is considered asymptomatic if a patient is a carrier for a disease or infection but experiences no symptoms. A condition might be asymptomatic if it fails to show the noticeable symptoms with which it is usually associated. Asymptomatic infections are also called subclinical...
.
Pilonidal sinus
A sinusSinus (anatomy)
Sinus is Latin for "bay", "pocket", "curve", or "bosom". In anatomy, the term is used in various contexts.A sinus is a sack or cavity in any organ or tissue, or an abnormal cavity or passage caused by the destruction of tissue...
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
Pilonidal cysts are caused by a hereditary congenital defect in the skin of the lower spine. In prenatal development, the notocord, a precursor to the vertebral column, is not retained by the fetus. However, in the cases of pilonidal cysts, a part of the notocord remains in the skin. It is invisible. Instead of normal pores in the skin, the notocord is a set of long tracts that go deeper into the body. Which explains why more than one in eight men develop this condition but never know. These tracts can become clogged- not because of excessive sweat or bad hygiene, but because of normal buildup of oil and skin follicles in the area. When they become clogged, the mass moves deeper into the body and grows in size, forming a cyst. The longer the patient ignores the pain, the bigger the cyst gets.One proposed cause of pilonidal cysts is ingrown hair
Ingrown hair
Ingrown hair is a condition where the hair curls back or grows sideways into the skin. The ingrown hair condition is seen primarily among people having curly hair. It may or may not be accompanied by an infection of the hair follicle or "razor bumps" , which vary in size...
. Excessive sitting is thought to predispose people to the condition because they increase pressure on the coccyx
Coccyx
The coccyx , commonly referred to as the tailbone, is the final segment of the vertebral column. Comprising three to five separate or fused vertebrae below the sacrum, it is attached to the sacrum by a fibrocartilaginous joint, the sacrococcygeal symphysis, which permits limited movement between...
region. Trauma is not believed to cause a pilonidal cyst; however, such an event may result in inflammation of 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 sweat
SWEAT
SWEAT is an OLN/TSN show hosted by Julie Zwillich that aired in 2003-2004.Each of the 13 half-hour episodes of SWEAT features a different outdoor sport: kayaking, mountain biking, ice hockey, beach volleyball, soccer, windsurfing, rowing, Ultimate, triathlon, wakeboarding, snowboarding, telemark...
ing can also contribute to the cause of a pilonidal cyst.
The condition was widespread in the United States Army
United States Army
The United States Army is the main branch of the United States Armed Forces responsible for land-based military operations. It is the largest and oldest established branch of the U.S. military, and is one of seven U.S. uniformed services...
during World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
. More than eighty thousand soldiers having the condition required hospitalization. It was termed "jeep seat or "Jeep
Jeep
Jeep is an automobile marque of Chrysler . The first Willys Jeeps were produced in 1941 with the first civilian models in 1945, making it the oldest off-road vehicle and sport utility vehicle brand. It inspired a number of other light utility vehicles, such as the Land Rover which is the second...
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 coccyx.
Treatment
Treatment may include antibioticAntibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
therapy, hot compresses and application of depilatory creams.
In more severe cases, the cyst may need to be lanced or surgically excised
Excision
Excision is the alias of Jeff Abel, a dubstep DJ and music boss from British Columbia, Canada. He frequently works with fellow Canadian dubstep producers Datsik and Downlink. As one of the first dubstep producers and DJs in North America, he has played a significant role in the genre's growth in...
(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, one year may be required for complete granulation
Granulation tissue
Granulation tissue is the perfused, fibrous connective tissue that replaces a fibrin clot in healing wounds. Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size it heals...
to occur. Sometimes the cyst is resolved via surgical marsupialization
Marsupialization
Marsupialization is the surgical technique of cutting a slit into a cyst and suturing the edges of the slit to form a continuous surface from the exterior to the interior of the cyst. Sutured in this fashion, the cyst remains open and can drain freely...
.
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.
A novel and less destructive treatment is scraping the tract out and filling it with fibrin glue
Fibrin glue
Fibrin glue is a formulation used to create a fibrin clot. It is made up of fibrinogen and thrombin that are injected through one head into the site of a fibrin tear. Thrombin is an enzyme and converts the fibrinogen into fibrin between 10 and 60 seconds and acts as a tissue adhesive. It may also...
. This has the advantage of causing much less pain than traditional surgical treatments and allowing return to normal activities after 1–2 days in most cases.
Pilonidal cysts recur and do so more frequently 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.
Differential diagnosis
A pilonidal cyst can resemble a dermoid cystDermoid cyst
A dermoid cyst is a cystic teratoma that contains developmentally mature skin complete with hair follicles and sweat glands, sometimes clumps of long hair, and often pockets of sebum, blood, fat, bone, nails, teeth, eyes, cartilage, and thyroid tissue. Because it contains mature tissue, a dermoid...
, a kind of teratoma
Teratoma
A teratoma is an encapsulated tumor with tissue or organ components resembling normal derivatives of all three germ layers. There are rare occasions when not all three germ layers are identifiable...
(germ cell tumor
Germ cell tumor
A germ cell tumor is a neoplasm derived from germ cells. Germ cell tumors can be cancerous or non-cancerous tumors. Germ cells normally occur inside the gonads...
). In particular, a pilonidal cyst in the gluteal cleft
Gluteal cleft
The intergluteal cleft, also known as the natal cleft, the vertical gluteal crease, and the gluteal cleft, is the groove between the buttocks that runs from just below the sacrum to the perineum, so named because it forms the visible border between the external rounded protrusions of the gluteus...
can resemble a sacrococcygeal teratoma
Sacrococcygeal teratoma
Sacrococcygeal teratoma is a teratoma located at the base of the coccyx . It is thought to be a derivative of the primitive streak.-Natural history:...
. Correct diagnosis is important because all teratoma
Teratoma
A teratoma is an encapsulated tumor with tissue or organ components resembling normal derivatives of all three germ layers. There are rare occasions when not all three germ layers are identifiable...
s require complete surgical excision, if possible without any spillage, and consultation with an oncologist.
External links
- Pilonidal Cyst Advice - Advice on treatment and relief of pilonidal cysts
- Pilonidal.org – Pilonidal Support Alliance
- Pilonidal Disease
- Images of pilonidal disease and treatment - www.learncolorectalsurgery.com
- World Wide Wounds - in-depth information on the treatment and symptoms of the condition, with photographs.
- Pilonidal sinus – NHS Direct Online Health Encyclopaedia