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| {{SI}} | | For patient information, click [[Pilonidal cyst (patient information)|here]] |
| | {{Pilonidal cyst}} |
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| {{CMG}} | | {{CMG}} |
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| | ==[[Pilonidal cyst overview|Overview]]== |
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| ==Overview== | | ==[[Pilonidal cyst historical perspective|Historical Perspective]]== |
| A '''pilonidal cyst''' (from Latin meaning 'hair nest') is a blanket term for any type of skin [[infection]] near the [[coccyx|tailbone]].
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| ==Terminology== | | ==[[Pilonidal cyst classification|Classification]]== |
| It is a combination of two Latin words, pilus, meaning hair and nidal, meaning nest. The condition is now referred to as [[pilonidal sinus]] disease.
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| The term "pilonidal cyst" can be misleading, as a majority of the time, this is actually an [[abscess]].
| | ==[[Pilonidal cyst pathophysiology|Pathophysiology]]== |
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| ==Etymology== | | ==[[Pilonidal cyst causes|Causes]]== |
| It was discussed by Herbert Mayo in 1830.<ref name="title-eMedicine - Pilonidal Cyst and Sinus : Article by Robert Ringelheim, MD">{{cite web |url=http://www.emedicine.com/emerg/topic771.htm |title=eMedicine - Pilonidal Cyst and Sinus : Article by Robert Ringelheim, MD |accessdate=2007-11-18 |format= |work=}}</ref><ref name="title-">{{cite web |url=http://www.ispub.com/ostia/index.php?xmlPrinter=true&xmlFilePath=journals/ijs/vol11n1/vacuum.xml |title=The use of Wound Vacuum-assisted Closure (V.A.C.) system in the treatment of Recurrent or Complex Pilonidal Cyst Disease:
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| Experience in 4 Adolescent Patients |accessdate=2007-11-18 |format= |work=}}</ref><ref>Mayo H. Observations on injuries and diseases of the rectum. London: Burgess & Hill, 1833</ref> R.M. Hodges was the first to use the phrase "pilonidal cyst" to describe the condition in 1880. <ref>Hodges RM, Pilo-nidal sinus. Boston Med Surg J 1880; 103:485</ref><ref name="isbn-3-540-64046-0">{{cite book |author=Elsner, Peter |title=Handbook of Occupational Dermatology |publisher=Springer |location=Berlin |year=2000 |pages= 821 |isbn=3-540-64046-0 |oclc= |doi=}}</ref>
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| ==Presentation== | | ==[[Pilonidal cyst differential diagnosis|Differentiating Pilonidal cyst from other Diseases]]== |
| These are normally painful, occur somewhat more often in men than in women (though this is debatable), and normally happen in early adulthood (to the 30's). Although usually found near the tailbone, this painful condition can be found rarely in several other places, including the [[navel]] and [[armpit]].
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| ==Differential diagnosis== | | ==[[Pilonidal cyst epidemiology and demographics|Epidemiology and Demographics]]== |
| A pilonidal cyst can resemble a [[dermoid cyst]], a kind of [[teratoma]] ([[germ cell tumor]]). In particular, a pilonidal cyst in the [[gluteal cleft]] can resemble a [[sacrococcygeal teratoma]]. Correct diagnosis is important because all [[teratoma]]s require surgical complete excision, if possible without any spillage, and consultation with an [[oncologist]].
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| ==Causes== | | ==[[Pilonidal cyst risk factors|Risk Factors]]== |
| A traumatic event is not believed to cause a pilonidal cyst, such an event that has been known to inflame an existing cyst.
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| It is usually considered to be an acquired condition, but some consider it to be congenital.<ref name="pmid10950015">{{cite journal |author=da Silva JH |title=Pilonidal cyst: cause and treatment |journal=Dis. Colon Rectum |volume=43 |issue=8 |pages=1146–56 |year=2000 |pmid=10950015 |doi=}}</ref>
| | ==[[Pilonidal cyst natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| Doctors are not sure what causes a pilonidal [[cyst]]. An old theory is that a small and harmless cyst has always been present at birth, and that for some reason, it has become irritated and formed a painful [[abscess]]. Another explanation is that it is an [[ingrown hair]] that has formed an abscess. It is very rare to find hair follicles inside the cyst—however,it is very common for drained cysts to contain hair, though this is not thought to be the sole cause of the condition.
| | ==Diagnosis== |
| | [[Pilonidal cyst history and symptoms|History and Symptoms]] | [[Pilonidal cyst physical examination|Physical Examination]]| [[Pilonidal cyst laboratory findings|Laboratory Findings]] | [[Pilonidal cyst other imaging findings|Other Imaging Findings]] | [[Pilonidal cyst other diagnostic studies|Other Diagnostic Studies]] |
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| The condition was widespread in United States Army during World War II. More than eighty thousand soldiers having the condition required hospitalization.<ref name="title-Pilonidal disease. DermNet NZ">{{cite web |url=http://dermnetnz.org/acne/pilonidal-sinus.html |title=Pilonidal disease. DermNet NZ |accessdate=2007-11-18 |format= |work=}}</ref> It was termed "Jeep riders' disease," because a large portion of people who were being hospitalized for it rode in jeeps, and it was theorized that prolonged rides in the bumpy vehicles caused the condition.
| | ==Treatment== |
| | [[Pilonidal cyst medical therapy|Medical Therapy]] | [[Pilonidal cyst surgery|Surgery]] | [[Pilonidal cyst primary prevention|Primary Prevention]] | [[Pilonidal cyst secondary prevention|Secondary Prevention]] | [[Pilonidal cyst cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Pilonidal cyst future or investigational therapies|Future or Investigational Therapies]] |
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| == Treatment == | | == Case Studies == |
| Treatment for a pilonidal cyst usually begins when the patient goes to the doctor because of pain. It is treated as an infection, and a doctor might prescribe [[antibiotic]]s as well as hot compresses and the application of depilatory creams to the lower back and gluteal cleft. Often the cyst is [[lanced]], and [[surgery]] is a method that has met with some success for curing pilonidal cysts. Surgery on a cyst in the natal cleft may involve cutting out the skin and sinus in this area (excision), or [[marsupialization]]. If the wound is packed, the patient or someone close to the patient is trained to replace the gauze packings. They must be replaced daily for 4 to 8 weeks (but healing, and therefore bandage changes, can last up to 1 year). The condition can recur, even after surgery. The chance of recurrence is much greater if the wound is sutured in the midline, compared to excellent results if the resultant scar is away from the midline, thus obliterating the natal cleft and therefore removing the focus of shearing stresses. Some people develop a chronic non-healing [[pilonidal sinus]] which must be treated with surgical excision. Rarely do the complications of a pilonidal cyst result in death, however, due to the possibilities of infection from the abscess, the results of an overly untreated case may prove fatal.
| | [[Pilonidal cyst case study one|Case #1]] |
| | | ==External Links== |
| In recurring or non-healing cases, a Z-plasty may be used to reduce shearing stress on the resulting scar. The end result of the procedure is that the buttocks are effectively merged after the cyst is excised, preventing a relapse.
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| ==References==
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| {{reflist|2}}
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| ==External links== | |
| *[http://www.pilonidal.org/ Pilonidal.org] – Pilonidal Support Alliance | | *[http://www.pilonidal.org/ Pilonidal.org] – Pilonidal Support Alliance |
| *[http://www.mckinley.uiuc.edu/handouts/pilonidal%5Fdisease.html Pilonidal Disease] | | *[http://www.mckinley.uiuc.edu/handouts/pilonidal%5Fdisease.html Pilonidal Disease] |
| *[http://www.worldwidewounds.com/2003/december/Miller/Pilonidal-Sinus.html World Wide Wounds] - in-depth information on the treatment and symptoms of the condition, with photographs. | | *[http://www.worldwidewounds.com/2003/december/Miller/Pilonidal-Sinus.html World Wide Wounds] - in-depth information on the treatment and symptoms of the condition, with photographs. |
| *[http://www.paxcredo.net/pilo1.html Pilonidal Sinus Self Help Page] with patient accounts of treatment. | | *[http://www.paxcredo.net/pilo1.html Pilonidal Sinus Self Help Page] with patient accounts of treatment. |
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| {{Diseases of the skin and subcutaneous tissue}} | | {{Diseases of the skin and subcutaneous tissue}} |