Pilonidal cysts develop from a heritable abnormality on the buttocks in the upper mid-line. Patients are born with small openings referred to as sinus tracts; hair fibers accumulate and secondary infection (cysts) develop. The typical complaint is intermittent redness, tenderness, and drainage; patients who frequently sit have a higher risk. In fact, a pilonidal cyst has been described as the “jeep driver’s disease.” A pilonidal abscess can be very painful and may require urgent drainage in the office or the operating room.
Excision of the cyst and sinus tracts, drainage of infection, irrigation, open packing, and shaving are the principles of treatment. (Chronic infection and the mechanics of sitting down prevent primary wound closure.) The procedure is done under general anesthesia as an outpatient. Patients return to the office the next day for wound care education and resume work in five days with minimal disability.