If you’ve had a painful lump on your tailbone pop up out of nowhere, there’s often no need to worry. This is certainly a stressful experience but it isn’t cause for concern. A common cause of lumps on the tailbone and in the buttock region is pilonidal disease, which occurs when body hair punctures the skin, grows inward, and forms a cyst. A cyst is a soft, movable, fluid-filled lump that forms under the skin. Unlike some types of cysts, multiple pilonidal cysts can form in the same area simultaneously. These cysts can be recurrent, meaning that they fill up again after being drained. They can also become infected if bacteria or debris enter the cyst’s sinus (opening) through the skin. Needless to say, pilonidal disease can be a real pain in the butt.
Pilonidal disease mainly occurs in young adults, especially young men, but can happen to anyone at any age. Some factors that increase your chances of getting pilonidal disease are sitting down for prolonged periods, being overweight, having coarse body hair, and having a family history of subcutaneous, “below the skin”, cysts. In very few cases, pilonidal disease can transform into squamous cell carcinoma, a type of skin cancer. Having pilonidal disease without the proper intervention slightly increases your risk for squamous cell carcinoma.
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Pilonidal disease is treated surgically. Before surgery, an abscess formed by the infection of a pilonidal cyst can be drained and cleaned by a provider non-surgically. This involves cutting into the infected cyst, draining its fluid, packing the area with sterile gauze, and often includes an antibiotic regimen to avoid reinfection. This, unfortunately, does not prevent cyst reoccurrence. Common surgical options for recurrent pilonidal disease include the Gips Procedure and a complete cyst removal. The Gips procedure involves local or general anesthesia (“going to sleep”) and begins with the insertion of a small biopsy tool into the cyst. The surgeon cleans out the cyst contents, including any hair, and injects hydrogen peroxide, phenol, or another chemical to stop cyst regeneration. The wound is then packed. The benefit of this procedure is that it is less invasive than the removal surgery, however, there is a chance the cyst may reoccur. The cyst removal surgery is done under general anesthesia and cuts the cyst out of the surrounding subcutaneous connective tissue and fat. The skin and subcutaneous tissue are then sewn together to heal. This procedure may require a drain or negative pressure “‘vacuum” dressing and takes longer to heal, but there is virtually no chance of cyst recurrence.
If you still have questions to ask your doctor about pilonidal disease, some things you could ask include:
What is the best surgical option to remove this?
What is the recovery time?
How can I fit more activity into my daily routine?
How can I find ways to sit less?
What hair removal products work best to avoid cyst recurrence?
In summary, pilonidal disease is a recurrent skin disease that is caused by prolonged sitting on a hair, forcing it to grow inward and form a cyst that may become infected. Pilonidal disease is a common and easily treatable condition although it can be quite painful and diminish your quality of life. There are multiple management options that you can explore with your doctor to see what fits best with your needs and your lifestyle.
Bibliography
Basso, L., Pietroletti, R., Micarelli, A., Bicaj, A., Costi, U., Crocetti, D., D'Ermo, G., & Gallo, G. (2022). The impact of experience on recurrence rates after biopsy punch excision for pilonidal disease. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 24(8), 984–991. https://doi.org/10.1111/codi.16126
Eryılmaz, R., Bilecik, T., Okan, I., Ozkan, O. V., Coşkun, A., & Sahin, M. (2014). Recurrent squamous cell carcinoma arising in a neglected pilonidal sinus: report of a case and literature review. International journal of clinical and experimental medicine, 7(2), 446–450.
Gabor, Silvio MD*; de Lima Favaro, Murillo MD, MsC, FACS†; Pimentel Pedroso, Ruy Francisco MD*; Duarte, Bárbara Henriqueta Ferreira MD*; Novo, Rafaela MD‡; Iamarino, Ana Paula MD*; Ribeiro, Marcelo Augusto Fontenelle Jr MD, PhD, FACS§. Pilonidal Cyst Excision: Primary Midline Closure with versus without Closed Incision Negative Pressure Therapy. Plastic and Reconstructive Surgery - Global Open 9(3):p e3473, March 2021. | DOI: 10.1097/GOX.0000000000003473
Mayo Clinic contributors. (2024, October 4). Pilonidal cyst - Symptoms and causes. Mayo Clinic Diseases and Conditions; Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pilonidal-cyst/symptoms-causes/syc-20376329
Nemours Children's Health contributors. (2022). What’s the Gips Procedure? Treating Pilonidal Cysts (Video) (for Parents). Kidshealth.org; Neumors Children’s Health. https://kidshealth.org/en/parents/pilonidal_gips_animation.html
Sommovilla, J., & Johnston, W. (2024, March 20). Perianal Squamous Cell Carcinoma: A Rare Presentation of Longstanding Pilonidal Disease. ACS Case Reviews; American Cancer Society. https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v4n5/13-sommovilla-perianal-squamous-cell-carcinoma/
UVA Health contributors. (n.d.). Pilonidal Cyst. UVA Health Skin Care & Dermatology; UVA Health. Retrieved November 29, 2024, from https://uvahealth.com/services/dermatology/pilonidal-cyst
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