Pilonidal Cyst or Sinus

Pilonidal disease, commonly called pilonidal cyst or sinus, refers to chronic skin infection centered over the top of buttock near the tailbone area (sacrococcygeal region). It was thought to be caused by friction/minor trauma to the skin allowing shredded hair and skin debris to accumulate. Skin bacteria then causes infection. It can be an isolated cavity (often called pilonidal cyst, but it is not a true cyst) or in the form of sinus (a long tunnel with one or few skin openings) in the deeper layer of skin. It usually occurs in people of younger age (20s to 40s). It may go unnoticed for a long time until it becomes infected.

Symptoms of pilonidal cyst or sinus

Pilonidal cyst or sinus infection causes pain and swelling of the skin and soft tissue over the tailbone area. There may be cloudy fluid or pus drainage (with or without blood) from the area and it will be tender to touch and painful to sit or lie on the back. More severe infection may cause fever or chills, and pain over the lower back sometimes radiating down the legs. Given its location, it may be mistaken as perianal abscess or fistula. However a true pilonidal disease has no connection to the anus.

Diagnosis and treatment of pilonidal disease

Diagnosis is made by physical exam of the area. Acute infection typically needs incision and drainage of the abscess to relieve the infection, oral antibiotics alone may not be enough. Most of the time, Dr. Choi can perform the drainage procedure in her office under local anesthesia. Certain skin hygiene regimen are often recommended to prevent the cyst or sinus from getting infected again. These include keeping the skin clean and dry, hair removal, avoidance of tight-fitting clothings that trap moisture, etc. However if you have recurrent infection, you should consider definitive surgery to excise the pilonidal cyst or sinus. This is an outpatient procedure done in the operating room under general or spinal anesthesia, after the acute infection has subsided and at a time that is convenient to your activity schedule. While there are different approaches to the operation, Dr. Choi routinely performs the cleft lift procedure. This preferred technique is meant to minimize recurrence, allow faster recovery and return to normal activities, with straight forward wound care and excellent cosmesis.

Helpful links:


*American Society of Colon and Rectal Surgeons

**The Sternberg Clinic