Pilonidal cyst

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  • Sinus is formed by penetration of skin by ingrowing hair
    • Leads to foreign body granuloma reaction, sinus perpetuated by repeated bouts of infection
  • Carcinoma is rare complication of chronic, recurring pilonidal sinus disease

Clinical Features

Pilonidal abscess of buttox.
  • May present as a painless cyst, acute abscess, or recurring cysts with draining sinuses
  • Occurs in midline in the upper part of the natal cleft
    • Does not communicate with the anorectum
    • Because of proximity to anus can be confused for a perianal abscess

Differential Diagnosis

Anorectal Disorders


  • Clinical


  • I&D - longitudinal incision lateral to sacral midline
  • Antibiotics only needed if cellulitis is present
  • Refer to surgeon for recurrent disease
    • 40% recurrence rate
    • Refer for follicle removal after acute inflammation subsides (~1 wk)[1]

See Also


  1. Rosen's 7th Ed