Pilonidal Cyst

What is a pilonidal cyst?

A pilonidal cyst is a round sac of tissue that's filled with air or fluid. This common type of cyst is located in the crease of the buttocks and is usually caused by a skin infection. Pilonidal cysts are a common condition, with more than 70,000 cases reported in the U.S. every year. But many people feel too embarrassed to mention it — even to their healthcare providers.

Pilonidal cysts can cause pain and need to be treated. Pilonidal cysts can be a one-time (acute) problem or you may have chronic (returning) cysts. If they’re not treated, chronic pilonidal cysts can also lead to abscesses (swollen pockets of infection) and sinus cavities (empty spaces underneath the skin).

A pilonidal cyst (also called pilonidal cyst disease, intergluteal pilonidal disease or pilonidal sinus) is a skin condition that happens in the crease of the buttocks — anywhere from the tailbone to the anus. A pilonidal cyst can be extremely painful especially when sitting.

These cysts are usually caused by a skin infection and they often have ingrown hairs inside. During World War II, pilonidal cysts were often called "Jeep driver's disease” because they’re more common in people who sit often.

Who can get a pilonidal cyst?

Anyone can get a pilonidal cyst, but certain people are at higher risk:

• Men (men are three to four times more likely to be diagnosed with a pilonidal cyst than women)
• People between puberty and age 40 (the average age is between 20 and 35).
• Workers who sit all day (like truck drivers and office workers).
• People who have overweight/obesity.
• People with thick or rough body hair (this can run in your family).
• People who wear tight clothing (this can worsen the skin condition).

Is a pilonidal cyst hereditary?

In some cases, a pilonidal cyst can be hereditary (you can inherit it from a family member). Your family history can play a role in determining if you get pilonidal cysts, for example if rough body hair runs in your family.

Is a pilonidal cyst contagious?

A pilonidal cyst is a non-contagious skin condition — you can’t spread it (just like a pimple). Currently, many researchers believe that pilonidal cysts are caused by ingrown hairs.

What causes a pilonidal cyst?

Experts don’t yet know all the causes of pilonidal cysts. However, they do know that ingrown hairs found in the crease of the buttocks result in a skin infection that causes a pilonidal cyst to form. Think of this condition like getting a sliver of wood stuck in your skin, except it’s an ingrown hair instead.

If it’s not treated, a pilonidal cyst can possibly lead to an abscess or a sinus cavity. Those are both signs that the skin infection is getting worse.

What are the symptoms of a pilonidal cyst?

• Quickly get medical attention if you notice any of these symptoms:
• Pain which often gets worse when you’re sitting.
• A small dimple or large swollen area between your buttocks. This is usually the pilonidal cyst. You may notice the area is red and feels tender.
• An abscess with draining pus or blood. This fluid may be foul-smelling.
• Nausea, fever and extreme tiredness (fatigue).

Can I get a pilonidal cyst while I’m pregnant?

Although pilonidal cysts are much more common in men, pregnant women can get them too. If you’re experiencing pain in your buttocks, it could be a sign of a pilonidal cyst and not just a normal discomfort of pregnancy. It’s usually best in that case to contact your provider and get checked.

How is a pilonidal cyst diagnosed?

Your provider will start by giving you a full physical examination. During the exam they’ll check the crease of your buttocks for signs of a pilonidal cyst.

If you have a pilonidal cyst, it should be visible to the naked eye. Your provider might spot what looks like a pimple or oozing cyst. If so, they may also ask you several questions, including:

• Has the cyst changed in appearance?
• Is it draining any fluid?
• Do you have any other symptoms?

Very rarely, your provider may order a CT or MRI to look for any sinus cavities (little holes) which may have formed under the surface of your skin.

How is a pilonidal cyst treated?

If you are diagnosed with one or more pilonidal cysts, you will receive a treatment plan that best fits your individual case. This treatment will depend on the answers to several questions such as:

• Have you had a pilonidal cyst before?
• Have you also had any other skin issues (like an abscess or sinus) in the same area?
• How quickly are you recovering?

Depending on the severity of your symptoms, you may or may not need surgery to remove your pilonidal cyst. There are several other treatment methods available besides surgery, including:

• Draining the cyst: This procedure can happen right in your provider’s office. A small incision (cut) will be made to open and drain fluid from your infected cyst.
• Injections: Injections (phenol, an acidic chemical compound) can treat and prevent mild and moderate pilonidal cysts.
• Antibiotics: Antibiotics can treat skin inflammation. However, antibiotics can’t heal pilonidal cysts on their own.
• Laser therapy: Laser therapy can remove hair which otherwise might become ingrown and cause more pilonidal cysts to come back.

While waiting for your treatment, you can try to manage any pain you may feel by using a warm compress on the affected area to soothe your skin. You might also feel less pain when using an inflatable seat or mattress.

Will I need surgery for a pilonidal cyst?

If you have a chronic pilonidal cyst or it has gotten worse and formed a sinus cavity under your skin, it’s a serious case and you may need surgery to excise (remove) the cyst entirely. Afterward, the surgeon might either leave the wound open for packing (inserting gauze) or close the wound with sutures or a skin flap (skin taken from a healthy part of your body).

Whenever you have surgery, it’s important to take good care of your wound so it doesn’t get infected. Your provider will tell you how to keep your wound clean (including shaving the area) and how long you should keep it covered. They’ll also tell you the warning signs of infection and when you should call your provider.

Can a pilonidal cyst go away on its own?

Pilonidal cysts sometimes drain and disappear on their own. If you have chronic pilonidal cysts, your symptoms may come and go over time.

Can a pilonidal cyst be cured?

Pilonidal cysts can sometimes be cured with surgery and your skin might heal fully. However, even after surgery, a pilonidal cyst can remain as a chronic, returning condition. This is true especially if the condition has gotten worse or if pilonidal cysts run in your family.

How can pilonidal cysts be prevented?

There are several steps you can take to help prevent getting pilonidal cysts or to keep them from coming back. These steps include:

• Regularly washing and drying your buttocks (to keep the area clean).
• Losing weight (if you are currently overweight) to lower your risk.
• Avoiding sitting for too long (if your job allows) to keep pressure off the area.
• Shaving the hair around your buttocks (once a week or more). You can also try using a hair removal product to avoid getting ingrown hairs.

Is a pilonidal cyst fatal?

A pilonidal cyst is not fatal in itself. Aside from the pain you may feel, though, there’s always a chance that a cyst can pose several long-term health issues. These health risks can include:

• One or more returning cysts can form in the same area (or elsewhere, but typically in the crease of your buttocks). If your cyst comes back, you have chronic pilondial disease.
• Systemic infection (when an infection spreads throughout your body). Body-wide infection can quickly become life-threatening.
• Cancer (specifically squamous cell carcinoma or SCC). SCC is rarely caused by a pilonidal cyst. But this type of skin cancer can sometimes happen if you get a pilonidal cyst. If your provider diagnoses you with a pilonidal cyst, they’ll usually take a pus sample and test it just to be sure it’s not cancerous.

Be sure to see your provider if you develop symptoms of a pilonidal cyst.

Do I need to leave work if I have a pilonidal cyst?

Depending on your symptoms, you might need to take some time off of work if you have a pilonidal cyst. This condition can cause a lot of discomfort especially if you’re sitting for a long period of time. Talk to your provider about ways to be more comfortable at work and treatment options to relieve any pain caused by a pilonidal cyst.

A note from Cleveland Clinic

Although a pilonidal cyst is not life-threatening itself, it can become more difficult to treat and turn into a chronic condition if you don’t quickly seek help. That’s why it’s important to get an exam at the first sign of any symptoms of a pilonidal cyst. Always be open with your healthcare provider about your symptoms and concerns.