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Pilonidal Cyst

Pilonidal Cyst and Sinus: What’s the Difference?

Having a pilonidal disease can be quite troublesome. From the acute pain in the natal cleft (the deep groove running between the two buttocks from the sacrum to the perineum) to the embarrassment of having an infection in such an awkward place, many people do not talk about it even to their physicians. However, pilonidal disease is much more common than you may have originally thought. This condition is more common among men from puberty to the age of 40, and it is completely treatable in most cases. 

One of the common pilonidal issues that people face is the pilonidal cyst. However, if you decide to do a quick internet search for information, you may come across another term- pilonidal sinus- the two terms are often used interchangeably. Do these names refer to the same condition? Is there any difference between them? In this blog, we will explain what a pilonidal cyst and pilonidal  sinus are and why it is important to know the difference. 

Pilonidal sinus – What is it? 

Pilonidal sinus or PNS is a small tunnel or cavity in the skin, often found in the natal cleft. The exact reason for the formation of this tunnel is unknown. However, experts believe that they are formed due to a combination of hair ingrowth, hormonal changes during puberty, friction from clothes, or the pressure on the buttocks from sitting for long hours. Some people may even have multiple sinuses in the region that are connected under the skin. Hairy people are most commonly affected. 

The pilonidal sinus may not be noticeable other than a small dimple-like depression on the surface of the skin (pit). However, the sinus may get infected due to hair, dust, dirt and fluid getting sucked in its cavity with possibility of abscess formation (a pus–filled cavity with swollen and inflamed surrounding tissues) or a cyst (a closed sac filled with fluid). 

If your pilonidal sinus is infected, you may experience symptoms such as- 

  • Extreme pain while sitting or standing 
  • Reddened and sore skin around the region 
  • Swelling or cyst formation 
  • Presence of pus or blood discharge from the region accompanied by a foul smell 
  • Presence of hair coming out of the pits  
  • Formation of multiple sinus cavities in the skin 
  • Low-grade fever (However, this is less common)

    Pilonidal diseases like abscesses occur when the pilonidal sinus is infected. Now let us learn more about the pilonidal cyst. 

    Pilonidal cyst – What is it? 

    As discussed, a pilonidal cyst is a rounded sac of tissue filled with air or fluid that is formed in the natal cleft. These cysts are usually caused by skin infections, with the presence of ingrown hair inside. Although anyone can get a pilonidal cyst, men are three to four times more likely to develop them. The condition commonly occurs from puberty to the age of 40, and it is rarely seen after that. It is particularly common in hairy individuals.  

    It is believed that the undue pressure to the buttock region due to sitting for long hours causes the hair in the natal cleft to grow inwards, paving the way for the cyst formation. The disease is commonly found in people who need to sit all day for work, overweight people, individuals with thick and rough body hair, and individuals who wear tight clothing.  

    It has been noted that pilonidal cyst can be hereditary. If a close family member had it, you may be at higher risk of developing the cyst. However, it is non-contagious and will not spread to other regions. 

    If a pilonidal cyst is left untreated, it can lead to an abscess or form a sinus cavity. In either case, it needs medical attention to stop the condition from getting worse. A pilonidal cyst will have a noticeable dimple or swollen area between your buttocks causing chronic pain, especially while sitting. It is often accompanied by swelling and tissue tenderness. In case of abscess formation, the cyst may open into the skin and will be draining foul-smelling pus or blood. Some people also complain about nausea, low-grade fever, and fatigue as the infection progresses. 

    Treatment and management of a pilonidal cyst and pilonidal sinus 

    Once the diagnosis is confirmed, pilonidal cyst and sinus treatment can be carried out in several ways, depending upon the severity of the infection. Here are some of the techniques that can be used- 

  • An infected pilonidal cyst with no abscess can be treated with the help of antibiotics. However, it does not usually disappear completely and may get infected again. 
  • If the cyst is infected and contains pus, the proctologist may recommend draining the pilonidal abscess. A small incision will be made to the cyst to drain the infection and the pus from the cyst. 
  • The cyst can also be excised in its entirety and the wound closed with stitches.  
  • Pilonidal sinus can be treated with various techniques with the most popular currently being laser and endoscopic treatment (EPSiT). These avoid large wounds, and the patient can be discharged the same day and resume daily activities. 
  • Phenol injection is nowadays rarely used as results are much lower than modern techniques. 
  • Shaving the hair around the natal cleft is important during the healing phase, and it may also reduce the chance of the pilonidal disease occurring again.  
  • In recurrent cases, permanent laser hair removal may be advised.

    Experts recommend the following steps to prevent pilonidal cyst and pilonidal sinus formation or recurrence- 

  • Ensure proper hygiene of your buttocks, especially the natal cleft. Wash and dry it regularly. 
  • If you are overweight, work on reducing a few pounds to lower the risk. 
  • Avoid sitting for long hours to keep the pressure off the buttocks. 
  • Shave the hair around the region once or more every week. Use hair removal products if necessary, to avoid ingrown hairs.

    Cyst or sinus – Does the name matter? 

    As we discussed above, a pilonidal sinus is formed as a consequence of a pilonidal cyst or due to friction/wound in the natal cleft. So how does it matter if you use the terms interchangeably? 

    A cyst and sinus are named differently by your doctor to provide the right treatment. A cyst does not have an opening, therefore, endoscopic or laser treatments are not possible. In cases without infection, excision is the treatment of choice for pilonidal cyst. On the other hand, a pilonidal sinus has one or more opening in the skin and a variety of approaches can be used: excision, laser, endoscopic treatment, chemical agents, etc. 

    Having symptoms? 

    Are you worried that you may have a pilonidal cyst or sinus? Are you at risk of developing the condition or experiencing any of the above-mentioned symptoms? Book your appointment with Dr. Antonio Privitera today. 

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