Pilonidal Cysts

Jenna Wishnew, MD, FACS

General Surgeon located in Richardson, TX

A pilonidal sinus is a cavity in the skin located on the crease of the buttocks, anywhere from the tailbone to the anus. It may fill with fluid leading to formation of cyst or eventually become infected and become an abscess wherein tissue gets swollen and inflamed where pus collects. It frequently contains hair, dirt and other debris and can also have a foul odor once it starts oozing. It can cause pain and be a one-time acute problem that can be treated once or it may be a recurrent issue which may need a more aggressive surgical management. This is a common condition with more than 70,000 cases reported in the U.S. each year.


It is believed to be caused by changes in hormones, hair growth, and friction from tight clothing and sitting for long periods. It is when loose hairs grow in the wrong direction forcing hair to burrow back under the skin. The body will then react to it as a foreign body and launch an immune response to it causing inflammation, leading to a pilonidal cyst or abscess. Sometimes they can form multiple sinuses that connect under the skin.



  • Young adult white male, between puberty and age 40
  • Obesity/overweight
  • Inactive lifestyle
  • Sitting for long periods, or workers who sit all day
  • Having stiff/thick body hair can be hereditary
  • Wearing tight clothing



  • Broad-spectrum antibiotics – not to heal the sinus tract but for relief of infection or discomfort
  • Regularly remove hair or shave the site and pay particular attention to hygiene
  • Antibacterial wound dressing/packing
  • Incision and drainage
  • Surgical excision
  • Laser therapy for hair removal which might become ingrown and cause more pilonidal cysts/abscesses