What is the differential diagnosis for a pilonidal (pilonidal) cyst?

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Last updated: March 9, 2025View editorial policy

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Differential Diagnosis for Pilonidal Cyst

  • Single Most Likely Diagnosis
    • Pilonidal sinus or cyst: This is the most likely diagnosis given the presentation of a pilonidal cyst, which is a common condition characterized by a cyst or abscess in the skin at the bottom of the tailbone (coccyx).
  • Other Likely Diagnoses
    • Furuncle or carbuncle: These are infections of the hair follicles that can present similarly to a pilonidal cyst, especially if they occur in the same region.
    • Epidermoid cyst: A benign cyst that can occur anywhere on the skin, including the sacrococcygeal area, and may be mistaken for a pilonidal cyst.
    • Hidradenitis suppurativa: A chronic skin condition that involves recurrent, painful abscesses and nodules, which could be confused with a pilonidal cyst if it occurs in the same area.
  • Do Not Miss Diagnoses
    • Anal fistula: Although less common, an anal fistula could present with similar symptoms if it has an external opening near the coccyx, and missing this diagnosis could lead to significant morbidity.
    • Tuberculosis or other granulomatous infections: Rarely, infections like tuberculosis can cause cystic lesions in the skin that might mimic a pilonidal cyst, and missing such a diagnosis could have serious consequences.
    • Squamous cell carcinoma or other skin cancers: Although rare, skin cancers can present as chronic, non-healing lesions that might be mistaken for a pilonidal cyst, and early diagnosis is crucial for treatment.
  • Rare Diagnoses
    • Dermoid cyst: A rare type of cyst that can occur anywhere on the body, including the sacrococcygeal area, and might be considered in the differential diagnosis of a pilonidal cyst.
    • Teratoma: A rare tumor that can contain several different types of tissues and might present as a cystic lesion in the sacrococcygeal area, although this would be extremely uncommon.
    • Hydatid cyst (Echinococcosis): In endemic areas, a hydatid cyst caused by the Echinococcus parasite could potentially present as a cystic lesion in the skin and might be considered in the differential diagnosis, although it is rare.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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