Pilonidal disease (pilonidal cyst or abscess)
Pilonidal disease is a condition in which an abnormal pocket in the skin of the lower back is found usually near the tailbone at the top of the cleft of the buttocks. The cyst may cause virtually no symptoms — or possibly a bit of redness and swelling in the tailbone region — or it may become an open infected wound that drains for years, causing irritation, pain and embarrassment.
The condition tends to be found chiefly in teenagers and young adults between the ages of 15 to 24 years (males more than females).
Symptoms
- Pain at the site
- Swelling, redness
- Drainage of pus or blood from an opening in the skin that may be foul smelling
- Hair protruding from the cyst
- Fever (this is not common)
What causes pilonidal cysts?
No one knows exactly what causes pilonidal disease. Some have proposed that hair follicles in the midline of the lower back get blocked and cause a cycle of inflammation and infection that leads to abscess formation and a chronic wound. Others suggest that bits of hair – even from other parts of the body – can get caught in a small opening in the skin of the lower back and cause this same cycle of inflammation and infection.
No matter what the cause, patients with pilonidal disease can have multiple, recurring bouts of infection and discomfort. Some undergo repeat drainages of abscesses. Some undergo many operations in an attempt to remove the affected area. Too often, these operations fail to fully eradicate the disease.
Treatment options
An active pilonidal abscess must be drained, and this can usually be done in the emergency room or in the office under local anesthesia. After the urgent problem is addressed, a measured plan of action must be undertaken to prevent recurrence or worsening. While antibiotics and warm soaks are often prescribed and may offer symptomatic relief, surgical removal of the problem is usually the right answer.
Non-surgical approaches that have been tried include the application of phenol or other scarring agents to eradicate the area of chronic inflammation, as well as laser hair removal, in an effort to avoid hair entrapment. The surgeons at this hospital do not recommend these approaches as primary, or sole, treatments.
Surgical treatment
The surgeons in the Division of Pediatric Surgery have been offering two approachs to pilonidal disease.
In the case of minor disease – where the only signs and symptoms have been an abscess and/or pain and swelling – the small open area at the base of the tailbone (the pilonidal “pit”) is removed under local anesthesia, either in the operating room or in the office. By eliminating the area where hair follicles can get blocked and cause inflammation and infection, most patients can avoid having further complications of pilonidal disease.
For patients with advanced disease – open, chronic wounds and recurrent infections – more extensive operations are offered. One of the operations, known as the Bascom cleft lift procedure, which was pioneered by two surgeons in Oregon for adult patients, has been adapted by a handful of pediatric surgeons across the US. The operation, done under general anesthesia in the operating room, involves removing the affected tissue and covering the area with healthy tissue. A small suction drain is left under the skin to prevent swelling; the drain is removed two or three days after the operation when patients come back for a post-operative visit. All procedures are done on an outpatient basis and last about one-and-a-half hours.
Post-operative care at home
Patients are instructed to keep the wound dry and to avoid prolonged pressure on the wound for about a week post-operatively. Those that go home with a drain are taught how to empty the drain every day until it is ready to be removed. Patients are prescribed narcotic pain medication for a few days, but after a few days, acetaminophen and ibuprofen usually suffice.
Follow-up care
Patients undergoing pilonidal pit removal are seen two weeks after the operation. Patients undergoing more extensive operations are seen two to three days after the procedure to remove the drain. Subsequent follow-up are at two- and four-week intervals. All patients can be enrolled in a study with telephone and/or office follow-up requested to monitor long-term outcomes.
Contact us
Appointments may be made by calling 1-800-KIDS-DOC; or a secure request form for first-time appointments can be found here and a secure registration may be found here.