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Pilonidal cyst

Introduction

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Overview

Overview

A pilonidal cyst (from Latin meaning ‘hair nest’) is a blanket term for any type of skin infection near the tailbone. It is a combination of two Latin words, pilus, meaning hair and nidal, meaning nest. The condition is now referred to as pilonidal sinus disease. The term “pilonidal cyst” can be misleading, as a majority of the time, this is actually an abscess.

Historical Perspective

It was discussed by Herbert Mayo in 1830.[1][2][3] R.M. Hodges was the first to use the phrase “pilonidal cyst” to describe the condition in 1880. [4][5]

Causes

It is usually considered to be an acquired condition, but some consider it to be congenital.[6].

A traumatic event is not believed to cause a pilonidal cyst, such an event that has been known to inflame an existing cyst.

Differentiating Pilonidal Cyst from other Diseases

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 teratomas require surgical complete excision, if possible without any spillage, and consultation with an oncologist.

Epidemiology and Demographics

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 30’s). Although usually found near the tailbone, this painful condition can be found rarely in several other places, including the navel and armpit.

Diagnosis

History and Symptoms

Pilonidal cysts are often very painful, and typically occur between the ages of 15 and 35. Although usually found near the coccyx, the condition can also affect the navel, armpit or genital region,[7] though these locations are much rarer.

Some people with a pilonidal cyst will be asymptomatic.[8]

Physical Examination

A sinus tract, or small channel, may originate from the source of infection and open to the surface of the skin. Material from the cyst may drain through the pilonidal sinus. A pilonidal cyst is usually painful, but with draining, the patient might not feel pain.

Treatment

Medical Therapy

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 antibiotics as well as hot compresses and the application of depilatory creams to the lower back and gluteal cleft.

References

  1. โ†‘ “eMedicine -Pilonidal Cyst and Sinusย : Article by Robert Ringelheim, MD”. Retrieved 2007-11-18.
  2. โ†‘ “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”. Retrieved 2007-11-18. line feed character in |title= at position 122 (help)
  3. โ†‘ Mayo H. Observations on injuries and diseases of the rectum. London: Burgess & Hill, 1833
  4. โ†‘ Hodges RM, Pilo-nidal sinus. Boston Med Surg J 1880; 103:485
  5. โ†‘ Elsner, Peter (2000). Handbook of Occupational Dermatology. Berlin: Springer. p.ย 821. ISBNย 3-540-64046-0.
  6. โ†‘ da Silva JH (2000). “Pilonidal cyst: cause and treatment”. Dis. Colon Rectum. 43 (8): 1146โ€“56. PMIDย 10950015.
  7. โ†‘ Rao, Amrith; Sharma, Mohit; Thyveetil, Mabel; Karim, Omer (December 2006). “Penis: An Unusual Site for Pilonidal Sinus”. International Urology and Nephrology. 38 (3โ€“4): 607โ€“608. doi:10.1007/s11255-005-4761-5. |access-date= requires |url= (help)
  8. โ†‘ Doerr, Steven. “Pilonidal Cyst”. eMedicineHealth. p.ย 1. Retrieved February 8, 2013.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Historical Perspective

Overview

It was discussed by Herbert Mayo in 1830.[1][2][3] R.M. Hodges was the first to use the phrase “pilonidal cyst” to describe the condition in 1880. [4][5]

References

  1. โ†‘ “eMedicine – Pilonidal Cyst and Sinusย : Article by Robert Ringelheim, MD”. Retrieved 2007-11-18.
  2. โ†‘ “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”. Retrieved 2007-11-18. line feed character in |title= at position 122 (help)
  3. โ†‘ Mayo H. Observations on injuries and diseases of the rectum. London: Burgess & Hill, 1833
  4. โ†‘ Hodges RM, Pilo-nidal sinus. Boston Med Surg J 1880; 103:485
  5. โ†‘ Elsner, Peter (2000). Handbook of Occupational Dermatology. Berlin: Springer. p.ย 821. ISBNย 3-540-64046-0.

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Classification

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References

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Pathophysiology

Pathophysiology

Doctors are not sure what causes a pilonidal cyst.

Theories

  • 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. It is very rare to find hair follicles inside the cystโ€”however,it is very common for drained cysts to contain hair, though this is not thought to be the sole cause of the condition.
  • The condition was widespread in United States Army during World War II. More than eighty thousand soldiers having the condition required hospitalization.[1] It was termed “Jeep riders’ disease,” because a large portion of people who were being hospitalized for it rode in jeeps, and it was theorized that prolonged rides in the bumpy vehicles caused the condition.

References

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Causes

Overview

It is usually considered to be an acquired condition, but some consider it to be congenital.[1].

A traumatic event is not believed to cause a pilonidal cyst, such an event that has been known to inflame an existing cyst.

References

  1. โ†‘ da Silva JH (2000). “Pilonidal cyst: cause and treatment”. Dis. Colon Rectum. 43 (8): 1146โ€“56. PMIDย 10950015.

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Differentiating Pilonidal Cyst from other Diseases

Overview

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 asacrococcygeal teratoma. Correct diagnosis is important because all teratomas require surgical complete excision, if possible without any spillage, and consultation with an oncologist.

References

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Epidemiology and Demographics

Overview

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 30’s). Although usually found near the tailbone, this painful condition can be found rarely in several other places, including the navel and armpit.

References

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Risk Factors

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References

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Natural History, Complications and Prognosis

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References

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Diagnosis

Diagnosis

History and Symptoms | Physical Examination| Laboratory Findings | Other Imaging Findings | Other Diagnostic Studies

Treatment

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case Studies

Case #1

External Links
  • World Wide Wounds – in-depth information on the treatment and symptoms of the condition, with photographs.


Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]