(pi·​lo·​ni·​dal: Latin pilus hair + nidus nest) –  a hair-containing cyst of the skin occurring in the lower back near the upper crease of the buttocks.

A pilonidal cyst is an abnormal pocket in the skin near the tailbone usually between the cheeks of the buttocks (natal cleft), often at the upper end containing a nest of trapped hair, dirt and skin debris. When infected it may fill up with fluid or pus to cause the formation of an abscess. The condition can give severe pain in addition to redness and swelling.

A pilonidal sinus (PNS) is a small tunnel in the inside of the skin with an external opening at the top of the butt cleft that may ooze out pus and/or blood with a foul odor. This develops when the cyst gets infected and needs a vent out of the body.

The terms cyst, sinus, and abscess refer to different stages of the disease process.

• Cyst: not infected
• Abscess: a pocket of pus
• Sinus: opening between a cyst or other internal structure and the outside

Pilonidal cysts occur when the thick/coarse hair that grow in the crease of the buttocks, puncture the skin and become ingrown or embedded in it. The condition is not serious but can become painful if this cyst becomes infected (invaded) with bacteria. This can result in inflammation and pus, forming an abscess.

Once the abscess heals, either on its own or with treatment, a pilonidal sinus may develop. The sinus is like a pipe just under the skin with tiny openings to the surface of the skin discharging foul-smelling pus.

People with a pilonidal sinus need to take extra care of the area to prevent recurrent abscesses and infections.

Symptoms

Symptoms can range from mild to severe, depending on the level of infection and may include:

• a small dimple in the skin around the butt cleft
• irritation or discomfort around the area
• painful mass just above the tailbone, which may be an abscess
• oozing of a clear, cloudy, or bloody fluid
• red, tender area
• foul-smelling pus
• fever (rarely)
• nausea

Causes

The exact cause of the condition is not clear. Some of the common causes can be:

1. Loose hair that penetrate the skin.
2. Friction and pressure – skin and hair rubbing against each other
3. Tight clothing
4. Bicycling
5. Long periods of sitting

Certain factors can make one more susceptible to developing a pilonidal cyst/abscess/sinus. These are:

• Excess body hair in the region
• Stiff or coarse hair
• Male sex
• Younger adults (pilonidal cysts are most common in people in their 20s)
• Obesity
• Inactive lifestyle
• Occupation requiring prolonged sitting (people engaged in horseback riding, cycling, driving – cab and taxi drivers, etc.

Diagnosis

Your physician will ask about your symptoms and medical history. A physical exam is done. You might be referred to a surgeon for a physical intervention if you don’t respond to oral medications. There are no diagnostic tests required.

Treatment options

Your doctor can appraise you of the best treatment plan for your condition. The choice of treatment will depend on the extent of the condition and your general overall health. Treatment options include:

Hair removal

In minor cases, hair removal may be the first step in treating a pilonidal sinus, provided there is no infection. Hair removal options may include:

• shaving
• waxing
• laser hair removal
• epilation creams

Regular hair removal and maintaining good hygiene of the area may result in reduced surgical procedures and being able to return to normal activities. However, in some cases, hair removal may paradoxically increase pilonidal recurrence. Also, one needs to take care with certain hair removal techniques, as they may cause irritation or rashes.

Home Treatment

As with all localized infections under the skin, hot water soaks will draw out the infection. However, it will not completely cure the condition.

Abscess incision and drainage

The procedure is done at a doctor’s OPD. Under local anaesthesia the abscess is lanced, pus is drained, and the wound is packed with sterile gauze to help it heal from the inside out.

Pit Picking

Treating the abscess can help make the pilonidal sinus more visible and easier to treat. A few weeks after abscess drainage, your doctor may recommend a procedure called pit picking. Under a local anaesthetic the doctor will cut out the pit, or sinus, followed by a course of antibiotics.

This though relieves, usually is not a complete cure since abnormal tissue might remain. A recurrence is reported in many cases.

Homoeopathic Remedies for Pilonidal Sinus

A few easily available homoeopathic medicines for the treatment of Pilonidal Sinus with their benefits:

Myristica: One of the most effective homoeopathic remedies for pilonidal sinus, myristica is an antiseptic that promotes quick healing. It also prevents the sinus from getting larger and speeds up drying. The medicine is preferred in the initial stage of pilonidal sinus.

Silicea: It helps stop the drainage of pus from the pilonidal sinus. Usually, a silicea discharge is very foul-smelling and causes a lot of discomfort and embarrassment due to the odor.

Merc Sol: This medicine treats pilonidal sinus mainly in its later stages, bringing fast relief from sticky excessive discharge, alleviating soreness, itching and discomfort.

Hepar Sulph: It significantly reduces the pain and bleeding from the pilonidal cyst. It amazingly helps in getting rid of the stinging pain and soreness associated with a pilonidal sinus. This medicine is highly recommended in cases of recurrence after surgical removal.

Lycopodium Clavatum: Lycopodium works proactively on the discharge from the cyst. One may have fever and chills if the condition gets severe.

Calcarea Sulph: Aids in drying up of the pilonidal cyst by stopping the formation of yellow pus.

Phosphorus: A widely used medicine for pilonidal sinus, helps stop profuse bleeding and discharge. Phosphorus also relieves the burning in the skin due to pilonidal sinus.

Tips to follow if you have a pilonidal sinus

• Avoid wearing tight-fitting clothes.
• Maintain proper hygiene and use only mild soap to clean the area. Pat it dry gently post-bathing.
• Prevent excessive hair growth around the cleft near the tailbone. Excess and rough hair increase the chances of hair penetration into the cysts.
• Lose weight if needed.
• Avoid sitting for a long time on hard surfaces.
• Change your underclothing every day and if required twice a day. This will prevent the infection from spreading.
• Avoid rubbing/scratching the affected area.

Laser treatment for Pilonidal Sinus

When no medication is able to bring any desired result one can go in for minimally invasive laser treatment for a speedy recovery. It is a daycare procedure and the patient can be back home on the same day. The treatment doesn’t involve any cuts/stitches. Recovery time is about 5-7 days.  

Laser Hair Removal

Laser hair removal in the area has shown to be an effective means to avoid the recurrence of pilonidal cysts.

Pilonidal sinus tends to recur, so make sure that you consult your physician. Self-medication can be harmful and cause side effects.