Pilonidal Cyst

This is a fluid filled sac that is under the skin of the lower back, close to the creases of the buttocks.

Some are not visible and some may look like a pimple or dimple in the skin.

If it never gets infected, it usually doesn’t need any treatment or cause any symptoms.

If it gets infected, it is then called a pilonidal abscess.

The exact cause of pilonidal cyst is not known.

• It is believed that it forms when dead skin cells and/or loose hair is able to get trapped under the skin as we move.

  • The trapped skin cells and/or hair irritate the area, and the body tries to protect the area by creating a cyst around it.

  • The cyst is what causes the pain and then it can become infected.

Risk factors for developing a pilonidal cyst:

• Sitting a lot during the day.

• If you have been told that your child has a BMI (body mass index) over 85%.

• Being born with a sacral dimple or pit in the tailbone area.

• If family members have a pilonidal cyst.

• Wearing tight clothing that rubs on the tailbone.

• Having a lot of hair in the area, especially if it is coarse or thick.

• Teenagers who were assigned male at birth.

• Had an injury or trauma in the area.

• If your child has been diagnosed with polycystic ovarian syndrome (PCOS).

• Excess sweating in the area.

The diagnosis is made by your child’s healthcare provider after:  

• Asking you and your child (if able) about the symptoms.

• Examining your child.

Your child may have pain, redness and/or swelling in this area.

They may have a fever.

They may have drainage from the area.

• This may look like pus, blood, or be clear.

• The discharge may have a foul smell.

You may notice a lump in that area.

Your child may complain of pain with sitting or in other positions that put pressure on the area.  

Keep the area clean, wash and dry the buttocks area regularly.

• Using an antibacterial soap may help.

• Be sure to wash the area after any sweating.

• It is best to avoid scented products as they can irritate the area.  

If age appropriate, shave the area to decrease the amount of hair, or use a hair removal product to try to help minimize ingrown hairs from developing.

Schedule breaks from sitting to avoid continued pressure on the area.

• Work on proper posture when sitting.

Try to minimize activities that put a lot of pressure and cause a lot of friction in this area such as:  

• Bicycling, running, heavy weightlifting, horseback riding, and rowing.

Continue to work on a healthy lifestyle to maintain a healthy weight.

Allow air exposure when possible.

Avoid tight fitting clothing when possible.

Cotton is a good fabric choice because it allows the skin to breathe, which reduces irritation in the area.

Seeking treatment as soon any pain, redness, swelling, or any other symptoms start.

If the cyst is not causing any problems or symptoms, no treatment is needed.

If the cyst is irritated, but not thought to be infected, then the treatment plan is usually supportive care that includes:  

• Pain control with acetaminophen and ibuprofen.

• Epsom salt baths.

• Keeping the area clean and avoiding excessive sweating in the area.

• Avoiding vigorous activity (see list above in prevention).

• Avoid sitting for prolonged periods.

• Wearing loose fitting clothing.

• Allowing as much air exposure as possible.

• Shave or use hair removal products if age appropriate.

If the cyst has turned into an infection (an abscess), it is treated with antibiotics, and may need to be drained or cleaned out.

• Your child is usually referred to a pediatric surgeon for this.

• Continue with supportive measures noted above.

• Be sure to follow the directions for any medications your child is prescribed.  

Your child has a cyst and is having any of the symptoms above.

Your child has a fever.

You think your child needs to be seen.

You have any other questions or concerns.