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Pilonidal Cyst
Aka: Pilonidal Cyst, Pilonidal Sinus, Pilonidal Abscess, Pilonidal Disease
- Epidemiology
- Incidence: 70,000 cases in U.S. per year
- Infection occurs most often in males, age 16 to 30
- Predisposing factors
- Men
- Dark-skin
- Hirsutism
- Pathophysiology
- Pit forms at skin disruption in gluteal fold (may be injured by embedded loose hairs)
- Pit plugs with hair and keratin
- Pilonidal Cysts forms when drainage of pit is blocked, and abscess forms when infected
- Sinus tracts may also develop
- Symptoms
- Pain in gluteal fold
- No systemic symptoms
- Signs
- Midline tender swelling in gluteal fold over Coccyx
- Differential Diagnosis
- Hidradenitis Suppurativa
- Skin Furuncle or abscess
- Crohn Disease
- Perianal fistula
- Perianal Abscess
- Malignancy
- Management: Pilonidal Disease without Abscess
- Hair removal from the gluteal cleft
- Weekly shaving
- Consider laser Epilation
- Topical phenol helps prevent recurrence
- Fibrin glue (with or without surgical excision - see below)
- Management: Pilonidal Abscess
- Incision and Drainage under Local Anesthesia
- Do not make incision in midline (risk of non-healing)
- Make small incision lateral to midline
- Consider surgical referral for cyst and sinus excision
- Many surgical approaches exist (e.g. marsupialization, Healing by Secondary Intention, flap closure)
- See recurrence rates below
- Complications
- Pilonidal Abscess (surrounding Cellulitis may be present)
- Pilonidal Sinus Drainage
- Recurrent infections: 10 to 90%
- References
- Marx (2002) Rosen's Emergency Medicine, p. 1952
- Johnson (2019) Dis Colon Rectum 62(2): 146-57 [PubMed]