Pilonidal Cyst and Its Treatment

A pilonidal cyst is typically seen in the coccyx (tailbone) area, where hair collects under the skin and forms a cystic condition.

A pilonidal cyst is commonly found in the coccyx area, where hair collects under the skin, forming a cyst. Over time, the collected hair can create a hollow, leading to a skin infection. Symptoms can range from a small lump to a painful, discharging mass. Pilonidal cysts are treated with surgical intervention, depending on the course of the disease.

What is a Pilonidal Cyst and What Causes It?

Known in medical terms as "pilonidal sinus," a pilonidal cyst most often occurs in the coccyx area and forms in the intergluteal cleft, the groove between the two buttocks. A pilonidal cyst occurs when hair from the back, neck, or head falls into the coccyx and collects under the skin. The collected hair can form a cystic mass. It typically presents with symptoms like swelling, drainage, and pain. Pilonidal sinus disease occurs in 80% of male patients and is more common in young men aged 15-24 due to hormonal activity and a higher amount of body hair.

Pilonidal Cyst: Which Areas of the Body Does It Occur?

The pilonidal cyst complaint in patients is most commonly seen in the coccyx (tailbone) area. The reason it is more frequent in this region could be due to the presence of hair, the area staying moist, and the skin being thinner and more prone to infection. Additionally, the pressure placed on the coccyx area, especially from sitting, may facilitate the hairs embedding under the skin. In rare cases, pilonidal cysts can also form in the armpits, belly button area, and between the toes.

What Happens If Pilonidal Cyst Is Left Untreated?

In untreated cases, although a pilonidal cyst may not cause discomfort initially, it can develop into an inflammatory condition and cause infection in the later stages. If patients do not notice this condition or fail to seek medical attention, the cyst may grow, leading to the formation of multiple cavities and painful complications of pilonidal cysts. In cases where treatment is delayed, surgical interventions or surgery may become inevitable. Although rare, untreated pilonidal cysts, if left untreated for a long time, can lead to recurrent inflammation and eventually turn into a wound.

Non-Surgical Treatment Methods for Pilonidal Cyst

If detected early before it progresses too much, non-surgical treatment for pilonidal cysts may be possible. The main principle of non-surgical treatment is removing the hair follicle without disturbing the surrounding tissue. This is also known as drainage therapy in medical terms. In non-surgical treatments, the pilonidal sinus cyst is numbed with local anesthesia, and the area is cleaned of hair follicles. After non-surgical procedures, patients can resume their daily activities without needing bandages or wound care. Additionally, since patients do not require general anesthesia, the procedure is more comfortable for them, and treatment can be completed in just 5-6 minutes. Some non-surgical treatment methods include:

• Phenol Treatment: One of the most successful and commonly used non-surgical treatments for pilonidal cysts is phenol treatment. In this method, holes with inflamed discharge are widened, and the hair clumps and infection are completely removed. Finally, crystallized phenol is applied to the created cavity to complete the treatment. The procedure is performed under local anesthesia in 5-10 minutes, and the patient is discharged after 1-2 hours of observation. After the procedure, the patient can move comfortably. To ensure long-term success, patients must pay attention to hygiene.
• Laser Treatment: Laser treatment is a method that can be applied in the early stages of pilonidal cysts, especially when there is no infection. After cleaning the cyst, a laser probe is inserted through the existing fistula opening to burn the affected area without making an additional incision. The procedure is performed under local anesthesia, and like other treatments, the patient is discharged the same day and can resume daily activities.
• Microsinusectomy: A small incision of about 2 cm is made in the affected area, the area is cleaned, and the fissure is closed with cosmetic sutures.
• Silver Nitrate Method: This method, which has a low success rate according to scientific data, is typically used in the early stages of pilonidal cysts, before the disease progresses. It is similar to phenol treatment in principle. A fine device is used to enter the area where the hair is collected, and the area is cleaned. Then, the area is washed with a silver nitrate solution. After silver nitrate treatment, proper care of the affected area is crucial to prevent recurrence.

Complications of Pilonidal Cyst

If left untreated, pilonidal cysts can cause recurrent abscesses and fluid drainage, significantly disrupting the patient’s social life. Since the cyst is usually located in the coccyx area, some patients may hesitate to seek a doctor's examination. In such cases, the cyst's cavity may expand, leading to complications such as pain, discharge, and difficulty sitting.

Surgical Interventions for Pilonidal Cyst

If pilonidal cyst complaints are delayed or postponed, surgical operations may be necessary. Some surgical methods have a high healing rate and low recurrence risk. These surgeries include fistulotomy and curettage, marsupialization, Z-plasty, V-Y advancement flap, rhomboid flap, gluteus maximus myocutaneous flap, excision-primary closure, cystotomy surgery, endoscopic pilonidal sinus treatment, and the Bascom procedure. After surgery, patients are generally monitored in the hospital for 24 hours. During the first week, patients must have regular dressing changes and use painkillers and antibiotics. They can shower by applying waterproof bandages over the surgical site. For the first week after surgery, sitting on the wound may cause discomfort, and it is advisable to avoid heavy work. Finally, stitches are removed 10-15 days after surgery, and the patient can return to normal activities.

What Can Be Done to Treat and Prevent Pilonidal Cyst?

The likelihood of developing a pilonidal cyst is significantly reduced when general hygiene rules are followed, and cleanliness is maintained. Since pilonidal cysts typically form in the coccyx area, special attention should be given to cleaning this region. Men, in particular, should pay extra attention to cleaning this area. Some preventive measures for pilonidal cysts include:

• Paying Attention to Personal Hygiene: While hand, face, and dental hygiene come to mind when personal hygiene is mentioned, regularly showering or bathing every day is one of the best preventive methods for pilonidal cysts. Special attention should be given to cleaning the coccyx and belly button areas to prevent fissures.
• Developing Good Sitting Habits: Scientific studies show that maintaining a straight posture is beneficial for spinal health and can help prevent pilonidal cysts. People who spend most of their day sitting or driving for long periods should perform posture-correcting exercises to prevent pilonidal cyst formation.
• Controlling Weight: Overweight individuals, particularly those at risk for obesity, are more likely to develop pilonidal cysts. Although pilonidal cyst complaints may subside in overweight individuals, they may recur. Therefore, individuals with pilonidal cysts should manage their weight to improve the treatment outcome.
• Avoiding Tight Underwear and Clothes: Wearing tight underwear or pants that constrict the body can cause fallen hairs to collect in the affected areas. Patients with pilonidal cyst complaints should prefer loose, comfortable clothing, which can contribute to fissure treatment.