Pilonidal Cyst: Causes, Symptoms and Treatments

The pilonidal cyst is an abnormal formation located in the subcutaneous tissue, typically in the sacrococcygeal region, just above the intergluteal cleft. Its name derives from Latin, meaning "nest of hair," as it often contains embedded hair.

How does it develop?
Pilonidal cysts are believed to be mainly acquired. Factors such as repeated friction, pressure, and hair penetration into the subcutaneous tissue cause an inflammatory reaction. This irritation can lead to cyst formation or sinus tracts.

Risk Factors
Several predispositions increase the likelihood of developing a pilonidal cyst, including:

Age and Gender: Most common in young males aged 15–35.
Excessive Hair: Especially in the lumbar region.
Obesity: Increases friction in the intergluteal cleft.
Sedentary Lifestyle: Prolonged sitting periods.
Poor Hygiene: Can facilitate infections.

Complications
A pilonidal cyst may progress to various complications:

Pilonidal Abscess: Acute infection causing severe pain, swelling, and often purulent drainage.
Fistulas: Chronic tracts connecting the cyst to the skin surface.
Recurrence: Common if definitive treatment is not performed.
Systemic Infection: Rarely, uncontrolled infection can lead to sepsis

Diagnosis
Diagnosis is primarily clinical. Patients often report pain in the sacral area, swelling, and, at times, purulent or bloody drainage. Physical examination reveals a sinus opening or painful swelling.
In complex cases, imaging studies such as ultrasound or MRI can help assess cyst extension and the presence of fistulas.

Treatment
Management depends on the patient’s clinical status:

Acute Phase (Pilonidal Abscess):
Treatment requires urgent surgical drainage to relieve infection and pain. In this phase, complete cyst excision is usually avoided due to inflamed tissues that hinder healing.
Chronic Phase (Non-infected Cyst):
Elective surgery is chosen to prevent recurrence.

The Role of the Surgeon
The surgeon plays a pivotal role in all stages of pilonidal cyst management. From the initial diagnosis, leveraging clinical expertise and interpreting imaging tests, to deciding on the most appropriate treatment based on the disease stage. Their intervention ensures effective resolution and reduces the risk of complications or recurrence.