Does a pilonidal cyst result from an ingrown hair?

Pilonidal Cysts Are Caused by Ingrown Hair

Yes, pilonidal cysts do result from ingrown hair. Pilonidal disease is an acquired inflammatory condition characterized by hair penetration into the subcutaneous tissue, leading to foreign body reaction, chronic inflammation, and subsequent cyst and sinus formation 1.

Pathophysiology of Pilonidal Cysts

The pathogenesis of pilonidal cysts involves:

1. Hair penetration: Loose hair shafts penetrate the skin due to:

   • Constant friction in the affected area
   • Direct trauma to the region
   • Lack of proper hygiene 2

2. Foreign body reaction: The penetrating hair acts as a foreign body, triggering:

   • Inflammatory response
   • Formation of epithelialized tracts
   • Development of sinus tracts containing hair follicles 3

3. Clinical progression:

   • Initially asymptomatic
   • Development of complications (abscess formation, pain, discharge)
   • Potential for recurrence after treatment 3

Clinical Presentation

Pilonidal cysts typically present as:

• Firm, pink, nodular lesions
• Most commonly located in the sacrococcygeal region (natal cleft)
• May develop complications including cellulitis and abscess formation
• More common in young adults, with male predominance (3-4:1 male-to-female ratio) 3

Distinguishing Features

Pilonidal disease should be differentiated from:

• Coccygeal dimples: These are innocent findings in approximately 4% of the population. Unlike pilonidal cysts, coccygeal dimples:

  • Are located at or below an imaginary line between the tops of the gluteal cleft
  • Have no associated skin abnormalities
  • Are not associated with signs of tethering
  • Do not give rise to pilonidal sinuses or cysts 1

• Lumbosacral dermal sinus tracts (DSTs): These are located cranial to the gluteal cleft on the flat part of the sacrum and require surgical correction 1

Management Considerations

Treatment options include:

1. Conservative management: Often attempted but has high recurrence rates

2. Surgical intervention: Currently recommended due to high recurrence rates with conservative treatment alone 4

   • Excision (open or closed wound healing)
   • Incision and curettage

3. Emerging treatments: Laser and intense pulsed light (IPL) technologies have shown promise in reducing recurrence rates, especially in patients with hirsutism 5

Conclusion

Pilonidal disease is an acquired condition resulting from ingrown hair that penetrates the skin and causes a foreign body reaction. The condition predominantly affects young adults, especially males, and most commonly occurs in the sacrococcygeal region. While various treatment options exist, surgical intervention remains the mainstay of treatment due to the high recurrence rates associated with conservative management.