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The individual and their healthcare provider will decide on the type of treatment necessary based on several factors. This activity provides a broad and comprehensive description of the pilonidal disease and its various treatments. Pilonidal disease is a dermatological soft tissue process that is relatively common and affects both the pediatric population and adults. This activity highlights the role of the interprofessional team in examining, diagnosing, treating, and managing patients with this condition.
Pilonidal Sinus Cyst: From Initial Symptoms to Healing
You may not have any noticeable symptoms at first other than a small, dimple-like depression on the surface of your skin. Reviews have shown that the Karydakis flap procedure results in lower rates of pilonidal disease recurrence and complication than standard excision methods. People are also most likely to develop pilonidal cysts between puberty and 40 years old.
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Excision and primary closure or healing by secondary intention, including marsupialization, are primary therapy options for chronic pilonidal disease with sinuses. Although primary closure has been shown to have faster healing and less time off work than healing by secondary intention, recurrence rates are slightly higher. Flap-based approaches (e.g., rhomboid, Limberg, Karydakis, cleft-lift) can be used for patients with complex or recurrent disease who require a wide excision.
How Long Do Pilonidal Cysts Last?
If you are a man, are years old, or have thick and coarse hair, you are at increased risk of a pilonidal cyst. Also, if you sit a great deal for work or are overweight, you have a greater risk of developing a cyst. Although a pilonidal cyst is not life-threatening itself, it can become more difficult to treat and turn into a chronic condition if you don’t quickly seek help. That’s why it’s important to get an exam at the first sign of any symptoms of a pilonidal cyst.
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While pilonidal cysts can go away without surgery, most cases require minor surgery to remove a pilonidal cyst or to clear out the infection and treat a pilonidal cyst. It's usually an outpatient procedure, meaning you go home the same day. This can be done in your healthcare provider's office or emergency room using local anesthesia.
Pilonidal cysts are most common in men between puberty and age 40. The pain of an infected pilonidal cyst is often excruciating. It feels as if you were to press your tailbone up against the sharp corner of a table and hold it there. The ingrown hair often continues to grow under the skin, irritating the cyst and leading to an infection, which is known as a pilonidal abscess or boil.
What causes pilonidal cysts?
Signs and symptoms include cysts or sinus with drainage, subcutaneous tracts, or abscesses. The American Society of Colon and Rectal Surgeons (ASCRS) has released a clinical practice guideline to provide physicians with diagnosis and treatment options. An incision and drainage procedure is successful at treating a pilonidal cyst about 60 percent of the time.
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This would be done with a local anesthetic, meaning that the area around the cyst is numbed with an injection. The cyst can then be opened with an incision and drained of any fluid it contains. If your cyst has no symptoms and isn’t bothering you, nothing will likely need to be done. However, if your cyst becomes infected, your doctor will likely want to release it.
What is the outlook for a person with pilonidal sinus infection?
In fact, it will likely only be considered if other treatments have not worked. Most of the time, they can be treated effectively and won’t come back. However, they can become chronic, so it’s important to get treatment right away and to follow up with your healthcare provider. These cysts should be diagnosed and treated by a healthcare professional, preferably one with experience in surgical treatments for this condition. A pilonidal cyst can be painful, embarrassing, and affect your quality of life. The condition needs treatment to avoid it from becoming infected and causing more serious disease.
Don't assume that your entire surgical team knows what medications you are taking. Repeat it to them on the day of your procedure so they are aware of what you have been on and how much time has passed since you last took it. Don't forget to bring your insurance documents, identification, and any additional paperwork your surgeon requires on the day of the procedure.
During a Limberg flap operation, a doctor will make a rhomboid-shaped incision over the sinus and remove all affected tissue from the area. They will then create an incision in the surrounding buttock area and pull a fold, or flap, of skin over the initial sinus site. Pilonidal cysts and sinuses are both parts of the broader term pilonidal disease. Over-the-counter pain relievers like Tylenol (acetaminophen) should help ease the discomfort. If not, your healthcare provider may prescribe pain medicine to take on a short-term basis. Most people can return to work in two to four weeks after surgery.
After the abscess drains of pus, which may happen if it erupts on its own or with medical treatment, many patients develop a pilonidal sinus. The sinus is a cavity below the skin that connects to the surface through your pores. Because pilonidal cysts develop near the buttocks, they can cause shame and embarrassment. Remember that healthcare providers see these types of conditions all the time.
But there are a few things you can do at home to ease pain and discomfort in the meantime. Pilonidal cysts are more common in men and people who sit for long periods of time, such as office workers are truck drivers. You’re also more likely to get one of these cysts if you have thick, stiff body hair. Most people can resume their regular activities within a month of surgery. You’ll likely have a follow-up appointment with your doctor about 6 weeks after your procedure. The follow-up appointments depend on whether the wound packing materials need to be changed or if sutures need to be removed.
It’s important to arrange a ride before your procedure since you won’t be able to drive after receiving pain medication and general anesthesia. You’ll leave the hospital or surgical center the same day as your operation. Initial treatments include sitz baths, warm compresses, and antibiotics. After surgery, the surgical site will also need care, often with changing the dressings two or three times a week.
Pilonidal cysts can sometimes be cured with surgery and your skin might heal fully. However, even after surgery, a pilonidal cyst can remain as a chronic, returning condition. This is true especially if the condition has gotten worse or if pilonidal cysts run in your family. If you've had pilonidal cysts in the past, you might want to regularly shave the affected area or use hair removal products to reduce the risk of a new cyst. Pilonidal cysts can vary in size and may develop into painful abscesses or chronic infections if left untreated.
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