Pilonidal sinus disease is a real pain in the…backside

Dear Doctor: My brother told me he was having surgery to treat a pilonidal cyst. He told me that the condition was also called “pilonidal sinus disease.” What is pilonidal sinus disease?

A pilonidal (pie-low-NIE-dul) cyst or sinus is an abnormal area or sack in the skin that usually contains dead skin, oil and debris. A pilonidal cyst is commonly situated near the bottom of the spine near or at upper cleft of the buttocks.

The exact cause of a pilonidal cyst is uncertain, but it is associated with pressure in the area such as tight clothing or prolonged sitting. One theory proposes the pressure on and rubbing around of an area of excess hair or ingrown hairs in the skin causes a cyst to be formed around it that only increases in severity over time and with continued pressure. Another theory proposes there is a natural weakness in the area, and prolonged pressure or rubbing or friction can cause a pocket to form that becomes a cyst.

Pilonidal cysts commonly occur in young men. The cysts may go away, but they often recur. People who sit for prolonged periods of time, such as car, bus and truck drivers, are at an increased risk of developing pilonidal sinus disease, as are those who are obese and inactive.

A pilonidal cyst can become enlarged, inflamed, red, swollen, and extremely painful (abscessed). The area may rupture and drain through a small opening, producing pus, blood, or a foul-smelling drainage. The drainage may become a recurrent problem.

Treatment

Prescription antibiotics may be employed to treat any associated infection. The intact cyst can be drained through a small incision. If the area is chronically problematic, the best treatment is to have the area removed surgically. The surgical treatment of a pilonidal cyst is a complicated affair and can best be discussed with your surgeon. Some physicians believe that if a chronically infected pilonidal cyst is not removed surgically, there may be a slightly increased chance of developing squamous cell skin cancer in the area.

Prevention

Because pilonidal sinus disease is associated with obesity, inactivity, prolonged sitting and poor hygiene, avoidance of any or all of these factors is recommended.

If you notice any signs or symptoms of a pilonidal sinus disease, see your doctor. He or she can best diagnose the condition by examining the lesion and developing the most appropriate treatment plan for you.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.