From the Guidelines
A pilonidal cyst is diagnosed primarily through physical examination by a healthcare provider, looking for signs of inflammation, drainage, or a visible opening in the skin at the top of the buttocks crease. The doctor will examine the affected area, checking for tenderness, swelling, redness, and may gently press around the area to determine if there is pain or pus discharge. In most cases, no additional tests are needed as the physical appearance is distinctive enough for diagnosis, as suggested by the guidelines for skin and soft tissue infections 1. However, if there's concern about other conditions or complications, the doctor might order imaging tests like an ultrasound or MRI to visualize the extent of the cyst and any sinus tracts.
Some key points to consider in the diagnosis include:
- A recurrent abscess at a site of previous infection should prompt a search for local causes such as a pilonidal cyst, hidradenitis suppurativa, or foreign material 1.
- The benefits of adjunctive antimicrobial therapy in preventing recurrences are unknown, but culture and treatment based on the pathogen isolated may be considered 1.
- Pilonidal cysts form when hair penetrates the skin and becomes embedded, creating a foreign body reaction that leads to inflammation and potential infection, which explains their common occurrence at the tailbone area where friction and pressure are common.
- In some cases, if infection is suspected, a sample of drainage might be collected for laboratory analysis to identify bacteria causing the infection, and treatment should be based on the culture results 1.
From the Research
Diagnosis of Pilonidal Cyst
To diagnose a pilonidal cyst, the following methods can be considered:
- Physical examination: A pilonidal cyst typically presents as a lump or cyst on the skin, often in the sacrococcygeal region, and may be associated with pain, redness, and swelling 2.
- Medical history: The patient's medical history, including any previous instances of pilonidal disease or similar conditions, can be relevant in making a diagnosis 3.
- Visual inspection: The cyst can be visually inspected to check for signs of infection, such as redness, swelling, or pus drainage 2.
Diagnostic Considerations
When diagnosing a pilonidal cyst, the following should be considered:
- The location of the cyst: Pilonidal cysts are most commonly found in the sacrococcygeal region, but can also occur in other areas, such as the vault biparietal region 2.
- The presence of symptoms: Symptoms such as pain, redness, and swelling can indicate the presence of a pilonidal cyst 2.
- The patient's overall health: The patient's overall health and medical history can influence the diagnosis and treatment of a pilonidal cyst 3.
Treatment and Diagnosis
The diagnosis of a pilonidal cyst is often made in conjunction with treatment, which may involve:
- Surgical excision: The cyst can be surgically removed, either through an open or closed wound 4.
- Incision and curettage: This procedure involves making an incision in the cyst and scraping out the contents 4.
- Negative pressure wound therapy: This therapy can be used to promote healing after surgery 5, 6.