Pilonidal Cyst

 What is Pilonidal Cyst?

The term ‘Pilonidal’ is derived from the Latin word ‘pilus’ (hair) and ‘nidus’ (nest). The pilonidal cyst or pilonidal sinus (PNS) is a structured cyst that develops near the tailbone at the top of the buttocks crease, at a height above 4-5 cm from the anus.

It is also known as Tailbone cyst and is more predominant in men than in women and can cure within 4 to 10 weeks depending on the severity and the type of treatment provided.

Epidemiology

A pilonidal cyst is common and may happen to 25-26 people among 100. It is prone to white patients, or who are in their late teens or early twenties but rare in people aged above 45 years. It is common amongst people with SC site, hereditary pilonidal disease (PD), sedentary lifestyle.

History

During World War 2, the pilonidal cyst was very common and came to be known as the ‘Jeep Disease.’ More than 80,000 U.S. soldiers suffered from this disease and were hospitalized. This was because of the prolonged bumpy rides which caused irritation and lead to the development of a cyst.

Causes of Pilonidal Cyst

The cyst usually occurs due to the presence of hair, dirt and debris in this area. The unusual hair growth blocks the underlying skin and the surface gets embedded resulting in the formation of a cyst. Tailbone cyst is common in people who sit for an extended period of time, especially amongst truck drivers. The pilonidal cyst can also appear on the other parts of the body like in between the skin of the fingers which is possibly seen in dog groomers, barbers and sheep shearers.

During earlier times it was assumed that the pilonidal cyst was congenital (present at birth). But researchers still haven’t proved the exact reason for the occurrence, though the primary cause is said to be due to hair penetration in the skin. The other possible causes are:

  • Friction- skin rubbing against skin or rubbing against clothes
  • Hormonal changes
  • Repetitive injuries on the sacrococcygeal area

Risk Factors for Pilonidal Cyst

  • Family history
  • Reoccurrence of pilonidal cyst
  • Overweight
  • Sedentary lifestyle
  • Common in males
  • Local shaving
  • Young age

Symptoms of Pilonidal Cyst

The presence of a pilonidal cyst can be asymptomatic and can only be identified by a small opening in the skin. A few signs and symptoms can give a fair idea about it:

  • Pain in the lower back while standing & sitting
  • Redness & swelling
  • Discharge of blood or pus if the skin ruptures or pops
  • Foul smell
  • Tender& warm skin
  • Fever may or may not be present
  • Outcome of hair from the lesion
  • More than one sinus tract

Complications

  • Re-occurrence of the cyst
  • Abscess formation
  • Infection in the system
  • Squamous cell carcinoma (type of skin cancer)

Diagnosis of Pilonidal Cyst

Although pilonidal cyst does not require any imaging tests, doctors can identify it with some physical examination and by checking for a few symptoms. Further blood tests can be prescribed if the infection is severe.

Treatments for Pilonidal Cyst

If the pilonidal cyst is merely a dimple, it can be treated with broad-spectrum antibiotics but it will only relieve the pain and will not allow the infection to spread. But if it turns out to be a pilonidal abscess (pus-containing structure), it would require proper drainage through small surgeries.

Incision

If the cyst does not cause much irritation, then this method is preferred. Here, doctors make a cut near the cyst and drain out the pus while leaving the wound open with sutured shut.

Lancing

The treatment is also known as marsupialization and is done with the help of local anesthesia. Doctors remove the pus and hair from the cyst and complete it with dressing giving it the shape of a pouch. Few medications for healing might be prescribed and it can take about six weeks.

Injection

Phenol injection is a type of chemical compound which is used as an antiseptic and is injected several times to harden the pore and close. However, this treatment does not give the surety of its re-growth.

Surgery

Surgery is preferred when the pilonidal cyst recurs and is done under general anesthesia. Firstly the lesion is opened and the pus along with the hair follicles are removed and stitched. Dressing at regular intervals is necessary otherwise it will be wounded from inside. Shaving off this particular location can avoid the re-growth of hair.

If the pilonidal cyst is not adequately treated, then it has a chance of developing a kind of skin cancer called squamous cell carcinoma. But sometimes it is harder remove the whole cyst through surgery which is the main disadvantage.

Methods of Operation of Tailbone/Pilonidal Cyst

There are different methods for the excision of the tailbone cyst, but none of them are perfect. The surgery depends upon the complexity of the disease. However, the doctors may choose any of the following methods-

  • Closed the wound: It is used if the cyst is in remission. It helps to recover fast and the rate of relapse is reduced. After the removal of the cyst, the wound is sewn up leaving a portion for drainage. To heal the scars bandages should be done every day and after 8 to 14 days the stitches will be out.
  • Basco Method: In this process, the cyst under the skin is removed from the primary opening to the secondary opening where the central hole is entirely sewn and the secondary opening is for draining the fluid or pus. After the drainage from the wound, the infiltration is removed.
  • An Open wound: This method is selected when the cyst is complicated, and the chance of recurrence is lower. The recovery time is the longest i.e. 2 months, but it eradicates the cyst. Because of the suture of the wound at the bottom, the fluid drains naturally and it needs to be under close medical supervision.
  • Karydakis Method: Dr. Basco also helped in developing this method, so it often creates confusion with Basco method. But they are altogether different operations. In this procedure, the flap of skin is removed and the wound is made at the buttock crease. The possibility of relapse is decreased and the recovery of the injury does not take much time.

Therapies ECx (Pilonidal Cyst)

  • Usage of depilatory creams allows removing the cyst from the coccyx area which can have a positive impact on the treatment in the coccyx.
  • Anti-inflammatory drugs can reduce the inflammation and pain in the coccyx. To remove the symptoms of ECx, this is not the treatment and it has less effect than that of antibiotics.
  • Different species of microorganisms can cause the inflammation of the cyst in the coccyx. It is essential to pick the correct antibiotics which can be time-consuming and expensive because it is necessary to research the source of inflammation. Powerful broad-spectrum medicines should be taken, but it is also a temporary help with possible side effects.

Home Remedies

Few natural treatments can also reduce the infection, they include:

  • Warm Compresses
  • Tea tree oil
  • Apple cider vinegar
  • Castor oil
  • Epsom salt
  • Garlic

Pilonidal Cyst Surgery Aftercare

It is necessary to take care of the patients who have been through surgical treatment. These include:

  • Checking the area if it is infected again
  • Cleaning the area
  • Remove the hair from that portion time to time

If proper care is taken, then complete recovery is possible, but there are 40-50% chances of recurrence even after surgery.

Pilonidal Cyst Prevention

People who are prone to pilonidal cyst should try to prevent it beforehand. The area should be clean and dry accompanied by regular shaving or laser hair removal to stop it from recurrence. Sitting posture should also be changed and usage of coccyx cushion can avoid the pressure over tailbone. Weight loss can also prevent inflammation and infection. Besides proper hygiene is also necessary.

Pilonidal Cyst prognosis

Long-term prognosis is excellent for people who get a pilonidal disease at regular intervals. The development of squamous cell carcinoma may vary in case of prognosis because there can be several reasons behind its occurrence but death from pilonidal disease is a rare scenario.

References

  1. https://www.medicinenet.com/pilonidal_cyst/article.htm
  2. https://www.mayoclinic.org/diseases-conditions/pilonidal-cyst/basics/causes/con-20025007
  3. https://www.emedicinehealth.com/pilonidal_cyst/article_em.htm#what_is_a_pilonidal_cyst
  4. https://www.webmd.com/skin-problems-and-treatments/guide/pilondial-cyst#1
  5. https://www.healthline.com/health/pilonidal-cyst
  6. https://www.top10homeremedies.com/home-remedies/home-remedies-pilonidal-cysts.html
  7. http://allcysts.com/methods-of-operations-in-the-tailbone-cyst/ 

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