Pilonidal cyst
From Wikipedia, the free encyclopedia
| Pilonidal cyst Classification and external resources |
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|---|---|
| Two pilonidal cysts that have formed in the gluteal cleft of an adult male. | |
| ICD-10 | L05. |
| ICD-9 | 685 |
| DiseasesDB | 31128 |
| eMedicine | emerg/771 |
| MeSH | D010864 |
A pilonidal cyst, also referred as sacrococcygeal fistula, is a blanket term for any type of skin infection near the tailbone. The condition is also referred as pilonidal sinus disease. It is usually painful.
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[edit] Etymology
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]
[edit] Presentation
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 30s). Although usually found near the tailbone, this painful condition can be found rarely in several other places, including the navel and armpit.
[edit] Differential diagnosis
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.
[edit] Causes
A traumatic event is not believed to cause a pilonidal cyst, however such an event has been known to inflame an existing cyst.
It is usually considered to be an acquired condition, but some consider it to be congenital.[6]
Doctors are not sure what causes a pilonidal cyst. 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 due to pressure on the area.[7]
The condition was widespread in United States Army during World War II. More than eighty thousand soldiers having the condition required hospitalization.[8] It was termed "Jeep riders' disease," because a large portion of people who were being hospitalized for it rode in jeeps, and prolonged rides in the bumpy vehicles caused the condition because of irritation and pressure on the tailbone.
[edit] Treatment
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. Often the cyst is lanced, and surgery is a method that has met with some success for curing pilonidal cysts. Surgery on a cyst in the natal cleft may involve cutting out the skin and sinus in this area (excision). If the wound is packed, the patient or someone close to the patient is trained to replace the gauze packings. They must be replaced daily for 4 to 8 weeks (but healing, and therefore bandage changes, can last up to 1 year). The condition can recur, even after surgery. The chance of recurrence is much greater if the wound is sutured in the midline, compared to excellent results if the resultant scar is away from the midline, thus obliterating the natal cleft and therefore removing the focus of shearing stresses. Some people develop a chronic non-healing pilonidal sinus which must be treated with surgical excision and is bettered by relieving pressure on the tailbone.
[edit] References
- ^ eMedicine - Pilonidal Cyst and Sinus : Article by Robert Ringelheim, MD. Retrieved on 2007-11-18.
- ^ [http://www.ispub.com/ostia/index.php?xmlPrinter=true&xmlFilePath=journals/ijs/vol11n1/vacuum.xml 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 on 2007-11-18.
- ^ Mayo H. Observations on injuries and diseases of the rectum. London: Burgess & Hill, 1833
- ^ Hodges RM, Pilo-nidal sinus. Boston Med Surg J 1880; 103:485
- ^ Elsner, Peter (2000). Handbook of Occupational Dermatology. Berlin: Springer, 821. ISBN 3-540-64046-0.
- ^ da Silva JH (2000). "Pilonidal cyst: cause and treatment". Dis. Colon Rectum 43 (8): 1146–56. PMID 10950015.
- ^ Pilonidal cyst. Mayo Clinic. Retrieved on 2008-02-13.
- ^ Pilonidal disease. DermNet NZ. Retrieved on 2007-11-18.
[edit] External links
- Pilonidal.org – Pilonidal Support Alliance
- Pilonidal Disease
- World Wide Wounds - in-depth information on the treatment and symptoms of the condition, with photographs.
- Pilonidal Sinus Self Help Page with patient accounts of treatment.
