Pilonidal Cyst

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Pilonidal Cyst

Pilonidal cyst is a chronic recurrent disease that can occur in various parts of the body (intercostal fold, hands, navel, etc.), but is often located in the sacrococcygeal region.

It used to be considered a congenital disease, but today the prevailing theory is that of acquired growth, where the trapping of hairs in a deep and hairy middle gluteal fissure under stressful conditions (e.g. vehicle drivers), leads to intermittent and chronic fistula formation.

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The most basic cause of Pilonidal Cyst appearance has been shown to be essentially the fact that the hair “turns” inwards, resulting in inflammation and cyst formation.

The disease can manifest as a simple cyst, abscess or complex with multiple pores. The most common clinical manifestation is a painful inflammatory mass in the sacrococcygeal area with accompanying mild cellulitis often with the presence of stomata (pits). The disease rarely extends into the anus.

If an abscess develops (the cause of which is polymicrobial), drainage through an eccentric incision and cleansing of all hairs is required. Changes are required, dermal baths with topical antiseptics and shaving the area for 3 months; these will cure the disease in 60-70% of cases.

Rarely, chronic recurrent disease leads to the development of carcinoma (squamous cell carcinoma) requiring wide en block excision with fascia and biopsy of swollen lymph nodes followed by radiotherapy, with poor prognosis.


Among the symptoms, in addition to inflammation (pus within the cyst), there is also:

  • Pain
  • Redness
  • Swelling (puffiness)
  • Rarely there is also fever or nausea

How it is treated

Methods of treating Pilonidal Cyst include:


Recurrence is mainly due to infection and incomplete initial technique. Some similar surgery can be performed, but special treatment may be required for deep wounds that fail to close, such as flap transposition of a gluteus maximus flap.

Injection of fibrin glue and the use of VAC (Vacuum assisted closure, a pressure device for treating postoperative infections) seems to reduce recurrence and postoperative hospitalization time, while the use of drains or antibiotics does not affect the progression of the disease.

Prevention of coccygeal cyst consists of following all hygiene rules and removing hair from the back, lumbar and buttocks area. In all cases of pilonidal cyst, laser hair removal of the area is recommended for permanent hair reduction.