Pilonidal cyst: what it is, treatment, surgery and symptoms

 What is the Pilonidal Cyst?

Cyst is the formation of a pouch from any tissue in the body that can comprise air, liquid, pus or other fluid inside. Pilonidal cyst is a very common chronic disease, variant of the dermoid cyst, and usually appears in the terminal region of the spine (sacrococcygeal or sacrococcygeal region), popularly known as the coccyx, a few centimeters above the anus.

It received the name pilonidal, which means “nest of hairs”, because it is very common to find hair inside the cyst, in addition to fragments of skin, sebaceous glands and sweat glands. When the accumulation of this material results in inflammation, giving signs of infection and pus, the cyst is also called a pilonidal abscess .

Despite being known to occur in the coccyx region, the pilonidal cyst can also appear in the eyes, nose, armpits, scalp and around the navel.

The CID (International Classification of Diseases) of the pilonidal cyst is L05. For pilonidal cyst without abscess, the ICD is L05.9, and for pilonidal cyst with abscess, the ICD is L05.0.

Causes and risk factors

The causes of the disease are still controversial. Initially, it was believed that it was caused by a malformation that caused an accumulation of embryonic tissues in the subcutaneous region (below the skin), as it is the case with other variants of dermoid cysts. In other words, it was a congenital disease (present since birth).

However, in the United States, during the Second World War, there was a significant increase in the incidence in soldiers, a factor that led many researchers and doctors to believe that it could be an acquired disease.

Currently, therefore, it is believed that there are factors that cause the cyst to appear. Are they:

Ingrown hairs

The wires bend and penetrate the hair follicle again, where they continue to grow, being treated by the body as foreign bodies, which results in an inflammatory process. Often a small subcutaneous canal is formed before giving rise to the cyst (pilonidal sinus), and through this opening, material can come out of the bag.

The absence of the hair follicle (structure responsible for the generation of hair) in the bags indicates that the hair was not born in that place, but was pushed there.

Friction and pressure in the sacrococcygeal area

It serves both through the use of very tight pants and in cases of people who spend a lot of time sitting during the day, either at home, at work or doing some sport such as cycling or horse riding.

Heat and perspiration

Sweat accumulated inside the skin can result in an inflammatory process. Thus, obesity , physical inactivity and poor hygiene are factors that stimulate the occurrence of the cyst.

Traumas

There is no evidence that trauma in the sacrococcygeal region could be the cause of a cyst, but it is certain that they can lead to inflammation of a pre-existing cyst.

Folliculitis

It is the inflammation of the hair follicle and can break in the subcutaneous tissue, thus forming a pilonidal abscess.

When the cyst becomes infected and becomes an abscess, normally the bacteria responsible is Staphylococcus aureus, a germ that normally inhabits human skin.

The disease predominantly affects (about 80%) men, who generally have more body hair than women. Therefore, men who are more hairy or with curly hair are even more likely to have cysts, as well as those who have a deeper crease in the buttocks.

It is more common in young people between 15 and 30 years old, as they have wider hair follicles, which facilitates the penetration of hair into the skin, in addition to hormonal changes in the sebaceous glands, such as increased keratin. It is very rare in men over 40 years old.

Pilonidal Cyst Symptoms

As the symptoms only appear when there is an inflammatory process, some people can live with the disease for many years without knowledge.

When the cyst becomes an abscess, symptoms can be:

  • Edema;
  • Discomfort or pain in the intergluteal region;
  • Swelling with the formation of a nodule;
  • Local heat;
  • Redness;
  • Difficulty in sitting;
  • Fever;
  • Extreme tiredness;
  • Spontaneous drainage: even in cases where there is still no inflammation, a small orifice can be observed in the cyst region that facilitates the elimination of cloudy, smelly, yellowish to white liquid that can cause pain and itching;
  • In extreme cases, new holes appear and depending on their size, it is possible to see the hair inside and remove them. They can be mistaken for a perianal fistula.

The cyst can also develop into squamous cell carcinoma, a malignant tumor developed from epithelial cells, or to other types of cancer , such as basal cell carcinoma, sarcoma and melanoma . What makes it malignant is the triggering of a chronic inflammatory process.

Read more: How to treat Sebaceous Cyst and what remedies to use?

How is the diagnosis of the Pilonidal Cyst made?

Initially, the pilonidal cyst looks like any other dermoid cyst or sacrococcygeal teratoma.

The diagnosis is clinical and can be made by a proctologist, dermatologist, general practitioner or emergency physician. Who performs the surgery is the general surgeon or coloproctologist.

There is still no examination that specifically confirms the occurrence of the cyst. What can be requested is a complete blood count , an examination that performs the counting of the elements of the blood. When the blood count indicates that there is an increase in the rate of leukocytes, then there is the suspicion of the presence of an infectious disease in the body, which may or may not be a pilonidal cyst.

Pilonidal cyst is curable? What is the treatment?

The pilonidal cyst has no cure, because even after surgical intervention it can recur. Treatment does not usually cause major complications, but in more advanced stages or in cases of recurrence, it can be quite uncomfortable.

First cyst incidence

When the patient has never had a case of pilonidal cyst before and the cyst does not show signs of infection, a drainage of the contents of the bag is performed through a small incision in the skin under local anesthesia, usually in the office itself. In some cases, the doctor may prescribe an antibiotic. This treatment is usually not definitive, but in some cases, after drainage, the cyst does not appear again.

Cyst recurrence

In cases of reappearance or when the cyst is already in a very advanced inflammatory stage, surgery will be necessary after drainage, when the inflammatory and infectious process has already subsided.

The operation consists of applying spinal anesthesia or epidural with sedation, opening, scraping the inner wall, removing hair and cauterizing the wound. The duration is approximately 20 minutes. The cyst is removed en bloc and may include a few centimeters of fatty tissue and healthy skin around it. This prevents the cyst from manifesting again. In that case, the recovery time can reach 3 months.

After the procedure, it is common for the surgical wound to be left open, without suturing, so that natural healing occurs, which lasts about 8 weeks. This technique, known as healing by the 2nd intention, requires more care and a longer healing time. However, the risk of infection is much less than the risk of closed stitch surgery.

After surgery, a daily dressing should be performed to speed up the healing process. Daily, the wound is washed with gauze or cotton and saline and finally, a clean gauze is placed to protect, always taking care that hair does not fall on the wound again. Thus, healing is uniform. It is essential that the hands of whoever is doing the dressing are always clean.

Home treatments for pilonidal cyst

Home procedures can help to relieve the pain and discomfort of the pilonidal cyst. Because they are not scientifically tested, there is no evidence of their effectiveness.

Hot water

Relieves severe pain quickly and contributes to drainage. It can be applied to the area with a hot bath or through compresses:

  • Soak a cloth in hot water and remove excess water;
  • Leave the cloth over the cyst area for a few minutes;
  • Repeat the practice 3 to 4 times a day.

Turmeric

Natural spice with anti-inflammatory and antiseptic properties that can reduce pain on the spot, reduce inflammation and promote wound healing.

Also known as turmeric, it can be ingested in the form of a capsule, found in health food stores, or through a homemade paste:

  • Mix ½ cup of turmeric powder and 1 cup of water in a pan until smooth;
  • Bring to a boil and continue stirring;
  • Reduce the heat and let it boil until it thickens;
  • Place in a container in the refrigerator;
  • Apply over the cyst area;
  • Let it dry alone;
  • Repeat the action 2 or 3 times a day.

Aloe Vera

Very suitable for treating skin problems, it is a powerful ally against bacteria, viruses and microbes. In addition, it also heals wounds and reduces swelling.

Apply the Aloe Vera gel, which can be found in health food stores or made at home using the gel that comes out of the plant when it is cut. Heat this gel until it is warm and apply to the affected area, leaving it to act for 20 to 30 minutes. Repeat this remedy 3 to 4 times a day.

Organic apple cider vinegar

It has anti-inflammatory, antiseptic and antibacterial properties that also reduce pain.

  • Mix 2 or 3 teaspoons of organic apple cider vinegar in ½ cup of warm water;
  • Soak a cotton ball in the solution and place it in the area for approximately 1 minute;
  • Repeat the action 3 or 4 times a day.

Another alternative is to mix 1 tablespoon of the vinegar in a glass of warm water and drink it twice a day.

Black tea

Its acidic property prevents the cysts from getting worse and, because it is anti-inflammatory, promotes quick relief from pain and swelling.

  • Soak a bag of black tea in warm water for 5 minutes;
  • Remove from water and eliminate excess water;
  • Keep the tea bag over the affected area for 5 to 10 minutes;
  • Repeat the action several times a day.

Castor oil

Antiseptic, antibacterial and anti-inflammatory.

  • To obtain the desired effect, place it on a gauze or cotton ball and apply it carefully under the painful area;
  • Leave to act for 30 minutes and rinse with warm water;
  • Reapply 2 to 3 times a day.

Garlic

It is a great antibiotic and antifungal and, when ingested, boosts the immune system, fighting infections.

  • Crush a clove of garlic and apply to the cyst area;
  • Cover with gauze and allow to act for a maximum of 10 minutes;
  • Wash well and repeat the action 2 to 3 times a day;
  • It is not suitable for sensitive skin.

Another tip is to eat a clove of garlic followed by a glass of water twice a day.

Epsom salt

Magnesium sulfate, known as Epsom salt, can relieve pain by speeding the expulsion of pus. It has antibacterial and anti-inflammatory properties that also reduce swelling.

  • Mix 1 tablespoon with 1 cup of warm water until the salt granules dissolve completely;
  • Soak a piece of cotton with the solution and apply to the area for 20 to 30 minutes;
  • Make this medicine once a day.

Azadirachta indica leaves

The tree, known as Neem, provides leaves with antiseptic and antibacterial qualities, warding off infection.

  • Grind a handful of washed Neem leaves to make a paste;
  • Apply to the affected area;
  • Leave to act for 20 minutes and rinse with warm water;
  • Repeat 3 to 4 times a day.

In addition to the treatments mentioned above, you can also use other oils such as Jojoba Oil, Mint Oil and Sage Oil.

Try not to use creams or other cosmetics in the affected area.

Living together

Pilonidal cyst is a common disease that is not fatal. Its severity depends on how long it takes to make the diagnosis. As it is a disease that can reappear, it is very important that the patient is always aware of this possibility and adopts measures in order to prevent this from happening.

How to prevent Pilonidal Cyst?

One factor that can considerably increase the likelihood of a pilonidal cyst is sweating. To avoid it, keep the sacrococcygeal area always clean, taking more than one bath a day, if necessary.

As the presence of hair inside the skin is the main cause of cyst formation, a tip for men who have already had the disease or are predisposed to have it is to shave the area. The most suitable is laser hair removal, in which the heat interrupts the action of the hair follicles, preventing the hair from growing for a long time. However, there are also other alternatives, such as waxing, razor or depilatory cream.

It is also recommended not to sit for a long time or practice exercises that force the place, as well as not to wear clothes that keep the area very suffocated, in addition to always trying to maintain the ideal weight.


Although not well known, pilonidal cyst is a very common disease, especially among men aged 15 to 30 years. Therefore, it is necessary that they be much more careful, take preventive actions to avoid the cyst and seek medical help as soon as the suspicion arises.

Therefore, share this text with your friends and family, so that the knowledge of the disease reaches more people!

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