Pilonidal cysts: understanding them A pilonidal cyst is a painful condition that occurs in the crease between the buttocks, near the tailbone. It often starts as a small dimple or abscess and may develop into an infected area with pus, thus causing extreme discomfort and drainage. Sometimes these cysts contain hair, while in other cases, they don't. But often, it's a case of blocked or damaged hair follicles, or pits, which cause the inflammation and infection, rather than the presence of hair itself.

Pilonidal Disease and Hair

The word "pilonidal" means "nest of hairs," and it was hitherto believed by many that the hair alone was responsible for the disease. Hair is not always the culprit, though it may be one of the causes. About 50% of pilonidal abscesses, particularly in women, do not contain hair. The basic defect is the formation of midline pits in the skin that accumulate debris and eventually result in an abscess. Over time, these midline pits may expand, forming a pocket in the skin that is prone to infection.

The Difference Between a Cyst and an Abscess

Although the term "pilonidal cyst" is in common usage, it is often a misnomer. Most pilonidal cases are actually abscesses rather than true cysts. A cyst usually has a defined sac, whereas an abscess is a fluid-filled infection beneath the skin. In rare, long-standing cases, the body attempts to heal the abscess by lining it with epidermal cells, but this is uncommon. The real focus of treatment is addressing the root cause - the midline pits.

Understanding Sinuses in Pilonidal Disease

A sinus is a small tunnel or passageway which connects an infected abscess with the surface of the skin. Not all pilonidal abscesses develop into the formation of sinuses; however, if any do occur, they usually allow pus or blood to pass through these openings. In extreme cases, several sinuses can appear, making the situation much more complicated and difficult to cure. Sinuses generally occur below the location of the abscess and act as a symptom indicating that the infection is developing further.

Location and Extension of Pilonidal Abscesses

The typical location of a pilonidal abscess is at the top of the natal cleft of the buttocks, but in practice, the actual site may be highly variable due to the variable sites of origin of the pits. As the abscess fills with fluid, it expands along the path of least resistance. Sometimes it extends upward while in other instances it might extend downwards or to one side. Severe forms may involve multiple tracts, from the anus to the highest fold in the buttock. When an abscess develops near the anus, the condition may, in fact, be an anal abscess or fistula, which is a different condition and would require different treatment.

Who's at Risk?

The most common age group involved in the pilonidal disease is usually from 16 to 26 years. Males are commonly involved as compared to females, and among the other predisposing factors sedentary life, coarse body hair, and a familial history of pilonidal disease also makes the patient at higher risk for this condition. In rare cases, it has also been observed that even elderly individuals or children can present with a pilonidal abscess.

Sacral Dimples in Infants

Some babies have a small indentation in the skin near the base of the tailbone called a sacral dimple. Most are benign but some may have a risk for the development of pilonidal abscesses if infected. Parents should be aware of these dimples and have medical evaluation if these become red swollen or start to drain fluid.

Treatment of Pilonidal Abscesses

Pilonidal abscesses seldom resolve on their own and thus require medical intervention. Antibiotics and warm compresses can reduce the infection and alleviate some of the discomfort for minor cases. Surgical treatments, involving drainage or excision, are more often required to heal this condition. Those in search of further relief may find symptoms aided with natural remedies including warm salt baths, applications of tea tree oil, and herbal compresses; however, these should not replace professional medical advice.

The Importance of Early Detection

Early signs and symptoms, such as tenderness, swelling, or discharge, should not be ignored in pilonidal disease. The early detection of the condition allows for less invasive treatments and reduces complications. If left untreated, pilonidal abscesses can recur or become chronic, leading to long-term discomfort and more extensive surgical needs.

The Psychological Toll of Pilonidal Disease

Consistently living with pilonidal disease takes a great physical and emotional toll. The pain, associated with everything from sitting and walking to social engagements, is often accompanied by frustration and embarrassment. One should handle the condition with patience and draw support from experts in the medical profession and others who can relate to the problems caused by it.

Natural Remedies and Preventative Care

The basic prevention of a pilonidal abscess includes hygiene, avoiding long sitting, and keeping the area clean and dry. Periodic removal of hair will prevent recurrence. For this purpose, shaving or depilatory creams may be used. Medical treatments can be complemented with natural remedies such as aloe vera for soothing inflammation, turmeric paste for anti-inflammatory properties, and warm compresses for draining.