Pilonidal Cyst

What it is

A pilonidal cyst is a lesion that forms in the skin of the sacrococcygeal area, between the buttocks, when hair penetrates the skin and triggers an inflammatory reaction, creating a cavity with tracts. It is more common in young adults, in people with a lot of body hair and in those who remain seated for long periods. It can stay silent for years or present with pain, redness, swelling and discharge or pus through small openings — a pilonidal abscess, which is very painful. Diagnosis is made by examining the area. During an acute flare, the abscess is drained; to prevent recurrence, treatment is surgical, with removal of the cyst and tracts, and subsequent care includes removing hair from the area.

Most common symptoms

• Pain over the tailbone, between the buttocks, that worsens with sitting
• Redness, warmth and swelling at the site
• Discharge or pus draining from small openings in the skin
• Small hair-containing openings along the midline of the buttocks
• Fever and malaise when an abscess is present
• A lump or hardened area that comes and goes

Causes and risk factors

• Hairs penetrating the skin over the tailbone area
• Thick, abundant hair in the area
• Long periods of sitting and local friction
• A deep cleft between the buttocks and being overweight
• Excess sweating and moisture in the area
• Age between 15 and 30 and family history

How it is diagnosed

Diagnosis is made by examining the tailbone area, where the surgeon identifies the characteristic midline openings, with hair, discharge, swelling or signs of abscess, and assesses the extent of the tracts under the skin. Additional tests are generally not needed. Ultrasound can be useful to map out deeper collections and tracts before surgery, and discharge can be sent for culture when infection recurs. The condition needs to be distinguished from anal fistulas and other skin lesions.

How we treat it at Femi Saúde

During an acute episode, the abscess is drained in the office under local anesthesia, and antibiotics are used when the infection is more extensive. Once the acute phase has passed, treatment to prevent further episodes is surgical: the general surgery team at Femi Saúde removes the cyst and its tracts, choosing the technique based on the extent of the disease and the number of previous episodes, with the wound either closed or left to heal by secondary intention, which requires regular dressing changes. After surgery, removing hair from the area, local hygiene and care with prolonged sitting help reduce recurrence. The plan is individualized, with follow-up until the wound has fully healed.

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