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Pilonidal Cyst/Sinus/Abscess

Dr Ganesh Ramalingam

Specialist in General Surgery

Condition

Pilonidal Cyst In A Nutshell

  • A pilonidal cyst is a skin condition that occurs in the skin crease of the buttocks.
  • The condition is relatively common and has been linked to hygiene habits along with some genetic conditions.
  • Pilonidal cysts can cause great pain and will usually require medical intervention.
  • If left untreated, pilonidal cysts may lead to skin abscess (or boils) and also sinus cavities, which leave holes underneath the skin.
  • Surgery to remove the pilonidal sinus entirely is usually recommended. 

Table of Contents

Pilonidal Cyst

What Is A Pilonidal Cyst?

A pilonidal cyst, also known as pilonidal sinus, is a skin condition that occurs in the skin crease of the buttocks, specifically starting from your tailbone to the anus. They are a type of sac that is caused by a skin infection. The condition is relatively common, and has been linked to hygiene habits along with some genetic conditions such as chimerism. 

Pilonidal cysts can cause great pain and will usually require medical intervention. If left untreated, pilonidal cysts may lead to skin abscess (or boils) and sinus cavities, which leave holes underneath the skin.

What Causes A Pilonidal Cyst?

Pilonidal cysts are commonly linked to ingrown hairs found in the crease of the buttocks which results in a skin infection. The cyst develops as the sac which holds the hair follicle and skin debris starts to turn inflamed. When left untreated, a pilonidal cyst can turn into a sinus cavity which leaves a hole in the region where the infection developed.

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What Are The Symptoms Of A Pilonidal Cyst?

Patients with pilonidal sinus commonly experience pain in the lower back region (tailbone) all the way to the buttocks. The pain usually worsens when you are seated.

You may also experience the following:

  • Swelling along the area between the buttocks,
  • Reddening of the swelling
  • Pus or fluid that drains from the swelling
  • Feelings of nausea
  • Fever
  • Tiredness 

Pilonidal cysts should always be treated early before the infection develops and causes further complications. You are advised to seek professional medical advice if you should experience pain and swelling on your back. 

What Are The Risk Factors Of A Pilonidal Cyst?

Pilonidal cysts are a very common problem that affects mostly men in their youth. The risk for developing this condition increases with prolonged sitting, especially for people who sit for longer hours than the average person does throughout most of their day.

In general, you are at a higher risk of getting pilonidal cysts if you:

  • Are male (men are between 3-4 times more likely to develop this condition compared to women);
  • Are between the age of 20 and 35 years old;
  • Work long hours seated (eg. office workers and transport drivers);
  • Are overweight;
  • Frequently wears tight clothing

Pilonidal Cysts can also be hereditary if your family has a history of thicker and rougher body hairs. As a result of genetic factors, pilonidal cysts are more commonly contracted by patients of Indian heritage in Singapore.

How can Pilonidal Cyst Be Prevented?

If you want to lower your chances of developing a pilonidal cyst, then there are several steps that can help. These include: 

  • Washing and drying (to keep the area clean) regularly; 
  • Losing weight if overweight or obese because it will reduce pressure on areas where bacteria thrive in acne nodules; 
  • Avoid sitting for long periods of time and remain active by walking after a few hours

How Is A Pilonidal Cyst Diagnosed?

Pilonidal Cysts can be diagnosed through a physical examination. 

In most cases, your doctor will first do a visual check on the location of the irritation to determine if there is swelling or redness of skin. Once the region has been established, a physical examination is performed to observe if the cyst is merely a pimple or potentially infected. 

In rare cases, you may be further required to do an MRI or CT scan to determine if the pilonidal cyst has developed into a sinus cavity on your skin.

What Are The Treatment Options For A Pilonidal Cyst?

Treatment for Pilonidal Cysts may differ depending on the severity of the condition. This may include:

  • Antibiotics
  • Excisional Biopsy
  • Saucerisation

Antibiotics are considered a more conservative approach to treating pilonidal cysts. If you currently do not experience pain or inflammation at the cyst, you may be prescribed a wider range of antibiotics to aid in alleviating the condition. This will not heal your sinuses, but it can give relief from the infection and discomfort by treating many types or bacteria that are present in these areas. 

You will likely be scheduled for follow-up exams regularly with your doctor to check for signs of inflammation. Additionally, patients who are given the course of antibiotics would also have to pay attention to cleaning and shaving near this region of the cyst in order to prevent future infections.

For patients who are looking to remove their pilonidal cyst before it becomes infected, you may be advised to do an excision biopsy. 

An excisional biopsy helps to prevent the collection of pus inside the sinus and treats the sinus before it becomes an abscess. The procedure can be administered in the doctor’s clinic with local anaesthesia. 

Once the anaesthesia has been administered, a scalpel will be used to remove the cyst, this will remove all traces of hair, blood and fluid that could have formed inside the cyst. 

You will be given a sterile dressing to pack the wound and allow it to heal over the next four weeks. Following that, your surgical wound should have fully healed. 

For patients who experience infected or frequent recurrence of pilonidal cysts, you may be advised to consider saucerization to completely remove the cyst, along with the sinus tract(s).

Similar to the excisional biopsy, the surgery can be done at the doctor’s clinic. Local anaesthesia will be given to numb the surgical site. 

A scalpel will be used, but this time, instead of removing just the cyst, a deeper excavation will be made to open the lesions to ensure that the pus and debris are completely removed. Once the entire procedure to saucerise the location has been done, the wounds will be stitched close and dressed up. 

You will be advised to change the dressing regularly during the course of the recovery and the entire recovery process may take up to 4 weeks. 

What Happens If A Pilonidal Cyst Goes Untreated?

Treatment for pilonidal cysts, whether conservatively or invasively, is usually recommended. If left untreated, your pilonidal cyst could turn into an acute or chronic problem with the potential for more frequent outbreaks as well as life-threatening infections from bacteria growing on top of these sacs due to lack of appropriate treatment methods.

Untreated pilonidal cysts can also lead to sinus cavities forming on the crease of the buttocks, causing holes to appear permanently on the skin. 

Can A Pilonidal Cyst Come Back After Removal?

Even after surgical treatment, pilonidal cysts have been known to recur even after the skin has fully healed. This could be due to genetic factors along with lifestyle habits which could have caused the pilonidal cyst to form again. 

If you want to prevent pilonidal sinus from recurring, always ensure the region is kept dry and hygienic, you may also want to consider shaving to prevent hair and debris from accumulating along the tailbone to the buttocks. 

How Much Does It Cost To Treat A Pilonidal Cyst In Singapore?

The professional fees for a pilonidal cyst removal ranges from $1,000 to $3,000. Do note that the charges listed here refer to the doctor’s fees, this is before you take into account any hospitalisation fees along with your eligibility for insurance and claimables. To obtain an estimated fee for Pilonidal Skin Cyst removal, visit MOH’s Historical Transacted Bill Sizes and Fee Benchmarks.

To understand your financing options and out-of-pocket costs, speak to your insurer, or you may contact our friendly staff via WHATSAPP or call our CLINIC for assistance.

Can I Use My Medisave To Have My Pilonidal Cyst Removed?

Medisave can be used to pay for your pilonidal cyst removal. With the help of our experienced staff at G&L Surgical Clinic you will be able to make ease-of use of your Medisave for your pilonidal sinus treatment, however, there may be prevailing limits set on how much can be utilised in such procedures. Do not hesitate to approach us if you have concerns on your treatment plans and we will be glad to assist you with them. 

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