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Pilonidal cyst
See also in: Cellulitis DDx,Anogenital
Other Resources UpToDate PubMed

Pilonidal cyst

See also in: Cellulitis DDx,Anogenital
Contributors: Erin X. Wei MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

The spectrum of pilonidal disease includes asymptomatic sinuses and cysts as well as infected or inflamed cysts and localized abscess formation (also referred to as acute pilonidal disease). A pilonidal sinus results from a disruption of the epithelium in the gluteal fold overlying the coccyx, with formation of a small pit. Squamous epithelium gradually lines this cavity, which then plugs with hair or keratin, forming a cyst. Cysts can become inflamed or infected, and may rupture to form localized abscess formation. These abscesses contain a combination of skin and perineal flora. Chronic pilonidal disease is marked by draining sinus tracts or cysts with persistent drainage. Squamous cell carcinoma has been reported in chronic pilonidal cysts with incidence estimated to be around 0.1%; similar to squamous cell carcinomas that arise in chronic wounds, the biological behavior is thought to be more aggressive than squamous cell carcinomas that develop on sun-damaged skin.

Initially, pilonidal disease was believed to be congenital in nature and to represent a type of dermoid cyst. Current belief is that this is caused by excessive repetitive trauma to the sacrococcygeal region, illustrated by the prevalence of this problem among Jeep drivers in World War II (so called "Jeep disease").

Risk factors for pilonidal disease include male sex (adult), hirsutism, obesity, occupations requiring extended periods of sitting, and the presence of a deep natal cleft. Pilonidal cysts are more common in adolescence and young adulthood. Systemic signs and symptoms are rare.

"Barber's interdigital pilonidal sinus" refers to the reaction surrounding an entrapped cut or shaved hair, often seen in an interdigital space of a barber's hand. These cases represent foreign body granulomas rather than true cysts.

Codes

ICD10CM:
L05.01 – Pilonidal cyst with abscess
L05.91 – Pilonidal cyst without abscess

SNOMEDCT:
47639008 – Pilonidal cyst

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Cellulitis or Erysipelas
  • Fournier gangrene
  • Perianal abscess arising from the posterior midline crypt
  • Perirectal abscess
  • Hidradenitis suppurativa
  • Carbuncle
  • Furunculosis
  • Sacral Osteomyelitis
  • Anal fistula
  • Coccygeal sinus
  • Actinomycosis
  • Primary syphilis
  • Cutaneous tuberculosis
  • Cutaneous Crohn disease
  • Pyoderma gangrenosum
  • Ecthyma gangrenosum
  • Presacral sinus or dimple
  • Dermal sinus tract – Dermal sinuses are usually found above the gluteal cleft, while pilonidal disease is seen within the gluteal cleft.
  • Congenital anomaly (ie, Spina bifida)

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:09/09/2021
Last Updated:09/09/2021
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Patient Information for Pilonidal cyst
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Pilonidal cyst
See also in: Cellulitis DDx,Anogenital
A medical illustration showing key findings of Pilonidal cyst : Erythema, Perianal-anus, Sacral region of back, Sedentary lifestyle, Skin warm to touch, Tender cyst, Skin abscess
Clinical image of Pilonidal cyst - imageId=6731060. Click to open in gallery.  caption: 'A deep red nodule with overlying crust and scale at the superior intergluteal cleft (pilonidal abscess).'
A deep red nodule with overlying crust and scale at the superior intergluteal cleft (pilonidal abscess).
Copyright © 2024 VisualDx®. All rights reserved.