A pilonidal cyst is a cavity underneath the skin over the tailbone. Pilonidal literally means “nest of hair” because the cavity is often found to contain hair. Research indicates that it is an acquired disease resulting from impaction of debris and hair into the midline hair follicles which rupture, spreading infection beneath the skin. This condition is not hereditary.

Some people have no symptoms, therefore no treatment is necessary. Occasionally, pus accumulates in the cyst, causing pain and swelling in the tailbone area to form (abscess). When this occurs, a patient will experience a fever and sometimes acute pain and swelling in the tailbone area. Other people may develop low-grade infections with milder, recurring episodes of pain and swelling.

This problem is more common in young adults and teenagers. This condition is rare in patients over 40 years of age. It is three times more common in men than women.

Patients with an acute abscess can generally be treated in the doctor’s office. The doctor uses local anesthesia to numb the area. An incision is made to allow for drainage of pus. This immediately relieves pressure and decreases pain. Daily cleansing of the area in the bathtub or shower is important to keep hair and other debris out of the wound. The patient should return for follow up until the wound is healed. Healing occurs rapidly, and wounds are usually completely closed in three weeks. For patients with repeated episodes, or continuing infection, surgery may be required. This is done as an outpatient procedure at a hospital. In most cases, the cyst is opened, cleaned, and allowed to heal from the inside out. Stitches are often used, but they will dissolve in one to two weeks.  After surgery it is important to keep gauze in the wound to keep the skin edges separated until the wound fills in from the bottom. The patient typically returns to the office for follow up visits until the wound is healed. In some instances, a more complex procedure is necessary. Wound hygiene is the single most important part of caring for pilonidal disease. Careful cleansing and dressing of the wound will prevent infection or premature closure of the skin, both of which can lead to recurrent problems.

After surgery approximately 10 percent of patients will develop another cyst. To help prevent the development of another cyst, keep the area free from hair with a depilatory (hair removal) cream or by shaving the area. If hair is allowed to grow back, recurrence is much higher.