A pilonidal cyst is an infected hair follicle that occurs at the top of the buttocks. While the exact mechanism of how it occurs is not fully understood, an infection occurs at the base of the hair follicle at the base of the back and can track to areas in the skin and create an abscess. A pilonidal cyst typically is diagnosed after it gets infected and requires drainage of an abscess. Hairy individuals are at higher risk.
Pilonidal cysts always occur within the gluteal cleft at the top of the buttocks. They start in the midline, but may track out to either the right or left side where an abscess forms. Symptoms include pain, drainage of pus and a lump under the skin from chronic infection in these areas.
Treatment involves proper hygiene and use of a hair removal product to prevent additional infections of the hair follicles. In individuals who experience repeat infections, excision of the pilonidal disease may alleviate symptoms. Excision involves removal of both the inciting hair follicle in the midline and subsequent cavity that develops. The areas can either be closed directly, or left open to heal like a scab from the inside out. Each has its advantages and disadvantages that you will need to discuss with your provider.
There are many ways to surgically remove these cysts, including simple excision, creating a flap of the surrounding skin, or a “cleft lift.”