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DermatologicalICD-10: L05.91Affects approximately 26 per 100,000 people annually; more common in young men

Pilonidal Cyst

A pilonidal cyst is a pocket that forms in the skin at the top of the crease between the buttocks (natal cleft), often containing hair and skin debris. When infected, it becomes a pilonidal abscess, causing significant pain, swelling, and drainage. Pilonidal cysts are most common in young men and are thought to be caused by loose hairs penetrating the skin, often aggravated by prolonged sitting, friction, and sweating.

Symptoms

Pain and swelling at the base of the spine near the tailbone
Redness and warmth over the affected area
Drainage of pus or blood from a small opening (sinus) in the skin
Foul-smelling discharge
Fever in cases of significant infection
Tenderness that worsens with sitting or pressure

Causes

  • Loose hair penetrating the skin in the natal cleft
  • Friction from sitting for prolonged periods
  • Pressure on the tailbone area from tight clothing or repetitive activities
  • Bacterial infection of a clogged hair follicle in the buttock crease

Risk Factors

  • Male sex (3-4 times more common in men)
  • Age between 15 and 30 years
  • Thick or coarse body hair
  • Sedentary lifestyle or occupation requiring prolonged sitting
  • Obesity
  • Family history of pilonidal disease
  • Previous pilonidal cyst or abscess

Diagnosis

  • Physical examination of the sacrococcygeal area
  • Visual inspection of sinus openings and assessment of drainage
  • Imaging (MRI or ultrasound) is rarely needed but may be used for complex or recurrent cases

Treatment

  • Incision and drainage of the pilonidal abscess under local anesthesia
  • Antibiotics for surrounding cellulitis or systemic infection
  • Excision surgery to remove the cyst and all sinus tracts
  • Minimally invasive procedures (endoscopic pilonidal sinus treatment, laser ablation)
  • Wound packing and regular dressing changes for open wound healing
  • Hair removal (shaving or laser) around the surgical site to reduce recurrence

Prevention

  • Keep the natal cleft area clean and dry
  • Remove hair from the buttock crease by shaving, waxing, or laser hair removal
  • Avoid prolonged sitting—take regular breaks to stand and move
  • Maintain a healthy weight to reduce pressure and friction
  • Shower and change clothing after sweating

When to See a Doctor

  • You notice a painful lump or swelling near the tailbone
  • The area becomes red, warm, and begins draining pus
  • You develop fever along with tailbone or buttock pain

Frequently Asked Questions

Related Conditions

Cellulitis

Infectious

Acne Vulgaris

Dermatological

Obesity

Metabolic

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