Pilonidal cyst

Pilonidal cyst, dermoid cyst or sinus pilonidalis are different names for the same disease.
It is still debated whether it is a congenital or acquired lesion, but it seems more likely to be an acquired lesion.
The disease is twice as common in men as in women and typically affects the younger age group (16-30 years), with about 26 new cases per 100,000 inhabitants per year.
Risk factors for the development of the disease include obesity, sedentary lifestyle, high hair growth, hereditary factors and congenital features (deep cleft between the two buttocks).
The lesion is caused by hairs and bristles around the anus, mainly above the sacrum in the area between the two buttocks, which, through mechanical trauma or constant renewal and movement of the skin cells, are pushed into deeper layers, where they can then form a small cavity or inflammation and then an abscess under the skin.
If an abscess develops, it may be accompanied by pain, swelling and redness around the rectum, sometimes accompanied by fever.
In the case of an abscess, immediate surgical exploration is necessary.
In cases where an abscess does not develop or the area calms down after surgical exploration, a chronic condition with recurrent episodes of inflammation usually persists.
Tiny fistula openings (pits) can be seen in the skin, often with the presence of hair in the openings.
In such cases, permanent medical hair removal is recommended as a first step, which in most cases is also a therapy, as the re-growth (hairs and hair follicles) is eliminated and the inflammation can be resolved.
If hair removal is not sufficient, some form of minimally invasive surgery is recommended as a first operation (pit picking surgery), which here for more information.
Unfortunately, the disease is prone to recurrence, which can be as high as 20-40%.
In recurring cases, or in cases of larger size, possibly with skin deformities, plastic surgery is often necessary.