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Pilonidal Cysts

What are Pilonidal Cysts?

Pilonidal cysts occur in the “gluteal crease” (butt crease) and develop because of the shape of that crease. In some individuals the crease is very deep, and remains folded all the time. The skin in the crease develops enlarged pores in the midline (we call them “pits”). Loose hairs that fall off the body can become caught in those pores and burrow their way under the skin. These hairs can form a pocket that we call a pilonidal cyst.

Who gets pilonidal cysts?

The most common age group are people in teens and twenties. These do not develop until a patient reaches puberty, or at least starts developing an adult shape. It is unusual for patients to develop these after age 40, but it does happen. This is more common in men than women; in our clinic, the ratio is 3:1. If a patient has a pilonidal cyst it will not go away just because they get older – and if it is not treated at a young age, it may become a problem later.

What kind of symptoms do they cause?

Pilonidal cysts can cause:

  • A tender lump
  • Bleeding or drainage from the gluteal crease
  • Sinus tracts that burrow from the midline pit to a spot off to the side
  • Painful infections (abscess)
  • Open wounds

How are pilonidal cysts treated?

There are many different types of treatment that have been used for pilonidal cysts. Some of these are very successful, and others have an extremely high failure rate. The types of treatment can be divided into two categories: surgical vs. non-surgical.

Non-Surgical Treatment for Pilonidal Cysts

  • Keep the area clean, possibly with antiseptic soap
  • Avoid trauma to the gluteal crease
  • Consider hair removal strategies. (This is controversial, and you can read my thoughts here.)
  • Apply antiseptics to the gluteal crease.
  • Wear loose clothing.
  • Tuck gauze in the gluteal fold to allow air circulation.

In general, these non-surgical options may help minimize symptoms for a while, but they are rarely a permanent solution.

Surgical Options for Pilonidal Cysts

  • Removal (excision) of the cyst. This is the most commonly performed type of operation, but has a failure rate over 50%.
  • Obliteration of the sinus or cyst (often called “minimally invasive pilonidal surgery”). This consists of removing the midline pits and any cysts or sinus tracts with small incisions, laser, a scope, or other destructive methods. The incisions are small and the recovery can be quick – but the success rates are unclear. Studies have shown up to a 62% recurrence rate of pilonidal problems in the first 5 years.
  • Flap operations. These are more extensive operations with varying success rates depending on the operation. The procedure with the highest success rate is the Bascom Cleft Lift, and this is what we perform in our clinic.

Conclusion

Pilonidal cysts are quite common, occur in young adults, and can be a source of pain, frustration, and embarrassment. However, they are quite treatable with modern surgical techniques. If you, or someone you know, are suffering from this condition, your best option is to find an experienced pilonidal surgeon, and it is our recommendation, that you consider the cleft lift operation.

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