A pilonidal cyst is a pocket that forms around a hair follicle in the crease between the buttocks. The area may look like a small pit or pore in the skin that contains a dark spot or hair. Sometimes the cyst can become infected, and this is called a pilonidal abscess.
Description
An infected pilonidal cyst or abscess requires surgical drainage. It will not heal with antibiotic medicines alone. If you continue to have infections, the pilonidal cyst can be removed by surgery.
There are several types of surgery.
Incision and drainage — This is the most common treatment for an infected cyst. It is a simple procedure done in your health care provider’s office.
- Local anesthesia is used to numb the skin.
- A cut is made in the cyst to drain fluid and pus. The hole is packed with gauze and left open.
- Afterward, it can take up to 4 weeks for the cyst to heal. The gauze has to be changed often during this time.
Pilonidal cystectomy — If you keep having problems with a pilonidal cyst, it can be removed surgically. This procedure is done as an outpatient procedure, so you will not need to spend the night in the hospital.
- You may be given medicine (general anesthesia) that keeps you asleep and pain-free. Or, you may be given medicine (regional anesthesia) that numbs you from the waist down. In rare cases, you may only be given local numbing medicine.
- A cut is made to remove the skin with the pores and the underlying tissue with the hair follicles.
- Depending on how much tissue is removed, the area may or may not be packed with gauze. Sometimes a tube is placed to drain fluid that collects after surgery. The tube is removed at a later time when the fluid stops draining.
It may be hard to remove the entire cyst, so there is a chance that it will come back.
Why the Procedure is Performed
Surgery is needed to drain and remove a pilonidal cyst that does not heal.
- Your provider may recommend this procedure if you have pilonidal disease that is causing pain or infection.
- A pilonidal cyst that is not causing symptoms does not need treatment.
Non-surgical treatment may be used if the area is not infected:
- Shaving or laser removal of hair around the cyst
- Injection of surgical glue into the cyst
Risks
Pilonidal cyst resection is generally safe. Ask your provider about these complications:
- Bleeding
- Infection
- Taking a long time for the area to heal
- Having the pilonidal cyst come back
Before the Procedure
Meet with your provider to make sure medical problems, such as diabetes, high blood pressure, and heart or lung problems are in good control.
Tell your surgeon:
- What medicines, vitamins, and other supplements you are taking, even ones you bought without a prescription.
- If you are or could be pregnant.
- If you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
- If you are a smoker, stop smoking several weeks before the surgery. Your provider can help.
- You may be asked to temporarily stop taking blood thinners, such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and any other medicines like these.
- Ask your provider which medicines you should take on the day of your surgery.
On the day of the surgery:
- Follow instructions about whether you need to stop eating or drinking before surgery.
- Take the medicines your surgeon told you to take with a small sip of water.
- Follow instructions on when to arrive at the hospital. Be sure to arrive on time.
After the Procedure
After the procedure:
- You can go home after the procedure.
- The wound will be covered with a bandage.
- You will get pain medicines.
- It is very important to keep the area around the wound clean.
- Your surgeon will show you how to care for your wound.
- After it heals, shaving the hair in the wound area may help prevent pilonidal disease from coming back.
Outlook (Prognosis)
Pilonidal cysts come back in about one half of the people who have surgery the first time. Even after a second surgery, it may come back.
Alternative Names
Pilonidal abscess; Pilonidal dimple; Pilonidal disease; Pilonidal cyst; Pilonidal sinus
References
Hyman N, Umanskiy K. Anus. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 53.
Johnson EK, Vogel JD, Cowan ML, et al. The American Society of Colon and Rectal Surgeons’ clinical practice guidelines for the management of pilonidal disease. Dis Colon Rectum. 2019;62(2):146-157. PMID: 30640830 pubmed.ncbi.nlm.nih.gov/30640830/.
Wells K, Pendola M. Pilonidal disease and perianal hidradenitis. In: Yeo CJ, ed. Shackelford’s Surgery of the Alimentary Tract. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 153.
Non-urgent advice: See a GP if:
- you have a lump on your skin and you do not know what it is
Urgent advice: Ask for an urgent GP appointment or get help from NHS 111 if:
- you have a sore or red lump on your skin
Treatments for a skin cyst
Skin cysts do not need to be treated if they’re not causing any problems.
But treatment may be recommended if you have:
- an infected skin cyst – you may be given antibiotics
- a large, painful cyst which interferes with everyday life – for example, a cyst on your head that catches when you brush your hair
Skin cyst removal
If you have a large, painful skin cyst which is making everyday tasks difficult, you may be able to have it removed on the NHS.
If it’s not causing any problems but is on a visible part of your body, such as on your face, you may choose to have it removed. But you’ll probably have to pay for this privately.
Local anaesthetic is used to numb the area around the cyst before it’s cut out. You’ll have a small scar after the wound has healed.
You may also get new skin cysts in the future.
Important
Do not squeeze a skin cyst. If it bursts it could become infected, or if it’s already infected you might spread the infection.
Types of skin cyst
There are lots of different types of skin cyst. Here are some of the main types.
A cyst that develops in the top layer of skin (epidermis)
Epidermoid cyst (sometimes known as a sebaceous cyst)
A cyst that forms in a hair follicle, usually on the scalp
Pilar cyst (also sometimes known as a sebaceous cyst)
A cyst in a joint or tendon, most commonly on the wrists, hands and fingers
A fluid-filled swelling on the back of the knee
A small, fluid-filled lump just inside the opening of the vagina
A small lump or swelling on the eyelid
Meibomian cyst or chalazion
Causes of skin cysts
Anyone can get a skin cyst and it’s not always known what causes them.
You may be more likely to get a skin cyst if:
- a family member also has cysts (particularly pilar cysts)
- you’re an adult, particularly in middle age
- you’re a woman
- you have acne
- you have a rare condition, such as Gardner syndrome
Skin cysts are not cancerous and you cannot get them from someone who has one.
