Causes of a Pilonidal Cyst and How to Remove It

Pilonidal cysts are cysts that form at the top crease of the buttocks, just below the base of your tailbone. Although many people have never heard of them, they’re actually pretty common: Every year in the United States, about 70,000 pilonidal cysts are treated.

Pilonidal cysts can be quite painful, especially if they become infected. At his offices in White Plains, New York, and on New York City’s Upper East Side, Michael Tarlowe, MD, offers prompt, skilled care for pilonidal cysts, providing relief and helping prevent serious infections. Here’s what you should know about this relatively common type of cyst.

Pilonidal cysts: Causes and risk factors

A cyst is a sac that’s filled with fluid and sometimes debris. Pilonidal cysts are filled with skin debris and hair. In fact, many cysts begin as ingrown hairs that become “trapped” beneath the skin. Once trapped, hair and other debris cause irritation that results in pus and other fluids forming inside the cyst. 

In its earlier stages, the cyst resembles a pimple, and it may feel tender and sore. When the cyst becomes infected, it’s called a pilonidal abscess, and it can become extremely painful. The skin will be red and tender to the touch, and foul-smelling pus may occasionally drain from the cyst.

Without immediate medical treatment, the infection can spread to surrounding tissues or cause channels to form under the skin, creating what’s called a pilonidal sinus.

No one knows for sure why these cysts form, but some potential risk factors have been identified, including:

Pilonidal cysts can occur at just about every age, but they tend to be more common between the teen years up until about age 40.

Treatment options for pilonidal cysts

Pilonidal cysts don’t respond to medication. Instead, they must be treated with a “hands-on” approach. Dr. Tarlowe offers several options, depending on your specific needs.

Drainage and cleaning

In this approach, Dr. Tarlowe makes an incision in the cyst to drain it of pus. Then, he cleans the area and removes hair and other debris. The incision site is packed with surgical gauze and allowed to remain open as it heals over the course of a few weeks. You’ll need to replace the gauze regularly to keep the area clean.


Like its name implies, this technique creates a small “pouch” around the incision by sewing together the edges of the wound. Marsupialization typically involves a smaller wound that doesn’t require you to replace your gauze every day. However, it does require a slightly longer healing time.

Closed wound

This approach begins like the first option, with an incision, drainage, and careful cleaning of the area. But instead of leaving the area open or creating a small pouch, Dr. Tarlowe sutures the incision closed, avoiding the need for gauze. 

Although avoiding gauze is a more convenient option, it’s difficult to remove the whole cyst using this approach. That means you can have a higher risk of recurrence or other associated problems, so it’s not the right approach for every person.

Custom care for a healthier you

Pilonidal cysts require a doctor’s treatment in order to relieve pain and prevent further problems. As a top-ranked proctologist in New York, Dr. Tarlowe is experienced in custom care options tailored for each patient’s unique health needs. To learn more about pilonidal cyst treatment, book an appointment online or call the nearest office to schedule an appointment today.

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