Pilonidal cyst
395667
226061271
2008-07-16T17:32:09Z
76.169.234.54
/* Differential diagnosis */
{{Infobox_Disease |
| Name = {{PAGENAME}}
| Image = Two pilonidal cysts in the natal cleft.jpg
| Caption = Two pilonidal cysts that have formed in the [[gluteal cleft]] of an adult male.
| DiseasesDB = 31128
| ICD10 = {{ICD10|L|05||l|00}}
| ICD9 = {{ICD9|685}}
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj = emerg
| eMedicineTopic = 771
| MeshID = D010864
}}
A '''pilonidal cyst''', also referred as '''sacrococcygeal fistula''', is a blanket term for any type of skin [[infection]] near the [[coccyx|tailbone]]. The condition is also referred as [[pilonidal sinus]] disease. It is usually painful.
==Etymology==
It was discussed by Herbert Mayo in 1830.<ref name="title-eMedicine - Pilonidal Cyst and Sinus : Article by Robert Ringelheim, MD">{{cite web |url=http://www.emedicine.com/emerg/topic771.htm |title=eMedicine - Pilonidal Cyst and Sinus : Article by Robert Ringelheim, MD |accessdate=2007-11-18 |format= |work=}}</ref><ref name="title-">{{cite web |url=http://www.ispub.com/ostia/index.php?xmlPrinter=true&xmlFilePath=journals/ijs/vol11n1/vacuum.xml |title=The use of Wound Vacuum-assisted Closure (V.A.C.) system in the treatment of Recurrent or Complex Pilonidal Cyst Disease:
Experience in 4 Adolescent Patients |accessdate=2007-11-18 |format= |work=}}</ref><ref>Mayo H. Observations on injuries and diseases of the rectum. London: Burgess & Hill, 1833</ref> R.M. Hodges was the first to use the phrase "pilonidal cyst" to describe the condition in 1880.<ref>Hodges RM, Pilo-nidal sinus. Boston Med Surg J 1880; 103:485</ref><ref name="isbn-3-540-64046-0">{{cite book |author=Elsner, Peter |title=Handbook of Occupational Dermatology |publisher=Springer |location=Berlin |year=2000 |pages= 821 |isbn=3-540-64046-0 |oclc= |doi=}}</ref>
==Presentation==
These are normally painful, occur somewhat more often in men than in women (though this is debatable), and normally happen in early adulthood (to the 30s). Although usually found near the tailbone, this painful condition can be found rarely in several other places, including the [[navel]] and [[armpit]].
==Differential diagnosis==
A pilonidal cyst can resemble a [[dermoid cyst]], a kind of [[teratoma]] ([[germ cell tumor]]). In particular, a pilonidal cyst in the [[gluteal cleft]] can resemble a [[sacrococcygeal teratoma]]. Correct diagnosis is important because all [[teratoma]]s require surgical complete excision, if possible without any spillage, and consultation with an [[oncologist]]. A pilonidal cyst is usually painful, but if it is draining, the patient might not feel any pain.
==Causes==
A traumatic event is not believed to cause a pilonidal cyst, however such an event has been known to inflame an existing cyst.
It is usually considered to be an acquired condition, but some consider it to be congenital.<ref name="pmid10950015">{{cite journal |author=da Silva JH |title=Pilonidal cyst: cause and treatment |journal=Dis. Colon Rectum |volume=43 |issue=8 |pages=1146–56 |year=2000 |pmid=10950015 |doi=}}</ref>
Causes for a pilonidal [[cyst]] include: being overweight and excessive sitting. Caucasians and males have more of a chance geting a pilonidal cyst.It is more common in people age 30+ than in younger peeple, but it can also happen to kids/teenagers. An old theory is that a small and harmless cyst has always been present at birth, and that for some reason, it has become irritated and formed a painful [[abscess]]. Another explanation is that it is an [[ingrown hair]] that has formed an abscess due to pressure on the area.<ref name="title-Pilonidal cyst. Mayo Clinic">{{cite web |url=http://www.mayoclinic.com/health/pilonidal-cyst/DS00747/DSECTION=3 |title=Pilonidal cyst. Mayo Clinic |accessdate=2008-02-13 |format= |work=}}</ref>
The condition was widespread in [[United States Army]] during [[World War II]]. More than eighty thousand soldiers having the condition required hospitalization.<ref name="title-Pilonidal disease. DermNet NZ">{{cite web |url=http://dermnetnz.org/acne/pilonidal-sinus.html |title=Pilonidal disease. DermNet NZ |accessdate=2007-11-18 |format= |work=}}</ref> It was termed "[[Jeep]] riders' disease," because a large portion of people who were being hospitalized for it rode in jeeps, and prolonged rides in the bumpy vehicles caused the condition because of irritation and pressure on the tailbone.
== Treatment ==
Treatment for a pilonidal cyst usually begins when the patient goes to the doctor because of pain. It is treated as an infection, and a doctor might prescribe [[antibiotic]]s as well as hot compresses and the application of depilatory creams to the lower back. Often the cyst is [[Lancing (surgical procedure)|lanced]], and [[surgery]] is a method that has met with some success for curing pilonidal cysts. Surgery on a cyst in the [[natal cleft]] may involve cutting out the skin and sinus in this area (excision). If the wound is packed, the patient or someone close to the patient is trained to replace the gauze packings. They must be replaced daily for 4 to 8 weeks (but healing, and therefore bandage changes, can last up to 1 year).
The condition can recur, even after surgery. The chance of recurrence is much greater if the wound is sutured in the midline, compared to excellent results if the resultant scar is away from the midline, thus obliterating the [[natal cleft]] and therefore removing the focus of shearing stresses. Some people develop a chronic non-healing [[pilonidal sinus]] which must be treated with surgical excision and is bettered by relieving pressure on the tailbone.
==References==
{{reflist|2}}
==External links==
*[http://www.pilonidal.org/ Pilonidal.org] – Pilonidal Support Alliance
*[http://www.mckinley.uiuc.edu/handouts/pilonidal%5Fdisease.html Pilonidal Disease]
*[http://www.worldwidewounds.com/2003/december/Miller/Pilonidal-Sinus.html World Wide Wounds] - in-depth information on the treatment and symptoms of the condition, with photographs.
*[http://www.paxcredo.net/pilo1.html Pilonidal Sinus Self Help Page] with patient accounts of treatment.
{{Diseases of the skin and subcutaneous tissue}}
[[Category:Surgery]]
[[Category:Skin diseases]]
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