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Pilonidal means hair nest, coming from Latin. Pilonidal cyst is a hair or debris filled cavity under the skin over the sacral bone close to the anal area. It is not an anal disease, still it is mostly treated by proctologists because it presents close to the anus and symptoms may seem like anal fistula.

When the cyst gets infected it is called pilonidal abscess. It is painful and red and either gets surgically drained by a small cut on the skin or bursts out to the skin by itself. Once it has a patent opening it is called pilonidal sinus. Pilonidal sinus discharges some smelly liquid on and off or may get closed again to a cyst or abscess. Pilonidal cyst/sinus/abscess is an unpleasant condition, it will not lead to any malignant disease but it will not heal without surgery. Laser is the least aggressive way of treatment with a high success rate.

What signs and symptoms one has with this problem?

Patients with pilonidal cyst might feel nothing or only a vague lump under the skin at the lowermost part of their back. Pilonidal abscess on the other hand is painful, the pain is throbbing, constant and only gets relieves in case the abscess bursts or gets drained surgically. Pilonidal sinus is not painful any more, but is discharging some smelly liquid, which would be noticed on the shirt or underwear. Sometimes only the smell is noted.

Pilonidal Sinus/Abscess