Symptoms of Pilonidal Cyst
Pilonidal cysts typically present as inflammatory nodular lesions in the sacrococcygeal region (natal cleft area) that may be asymptomatic initially but become painful when complications develop, particularly abscess formation with associated purulent drainage. 1, 2
Primary Clinical Presentation
Location and Demographics
- Predominantly affects the sacrococcygeal region (natal cleft of the buttocks), though rare cases occur on the scalp, interdigital regions, or other body sites 3, 2
- Most common in young males (male-to-female ratio 3-4:1), typically presenting toward the end of the second decade of life 2, 4
- Higher prevalence in obese, hirsute males 1
Symptomatic Presentation
Uncomplicated/Early Stage:
- Initially asymptomatic nodular lesions that patients may notice incidentally 2
- Solitary, firm, pink nodular mass in proximity to the gluteal cleft 2
- May present as a visible pore or dimple in the sacral region above the gluteal cleft 5
Complicated/Acute Stage:
- Pain - the hallmark symptom when inflammation or abscess develops 1, 3, 6
- Local infection with redness (erythema of overlying skin) 3
- Purulent drainage from sinus tracts 2, 4
- Swelling and tenderness to palpation in the affected area 3
- Draining sinus tracts that may develop with chronic disease 4
Associated Features
- Presence of hair shafts within or emerging from the lesion, as the condition results from hair penetration beneath the skin 1, 4
- Chronic sinus tract formation in recurrent cases despite previous drainage procedures 1
- Moderate debility in some patients with active disease 4
Clinical Examination Findings
Dermoscopic Features (when examined)
- Pink homogenous background color 2
- Central ulceration (red or yellow structureless area) 2
- Peripherally arranged dotted, glomerular, or hairpin vessels 2
- White reticular lines at the periphery 2
Important Clinical Distinctions
A pilonidal cyst must be distinguished from an innocent coccygeal dimple, which is located more caudally (at or below an imaginary line between the tops of the gluteal cleft forks), whereas pathologic pilonidal cysts are lumbosacral and located cranial to the gluteal cleft on the flat part of the sacrum 5
Complications to Monitor
- Cellulitis surrounding the affected area 3
- Abscess formation requiring drainage 5, 3
- Recurrent infection despite initial treatment 5, 1
When a recurrent abscess occurs at a site of previous infection, this should prompt a search for pilonidal cyst as a local cause 5