Learn about prevention, diagnosis and modern treatment techniques for pilonidal cyst

A pilonidal disease is an inflammatory condition that mainly affects the area near the coccyx. It is characterized by the accumulation of hair and skin debris under the skin, forming a cyst that can become infected and generate significant discomfort and, although it is more common in young adults, it can affect people of different ages and profiles.

Causes include genetic predisposition, ingrown hairs, constant friction and excessive perspiration in the area. Among the most common symptoms are pain, swelling, redness and the presence of a secretion, which can indicate the development of an ingrown hair. pilonidal abscess. In chronic cases skin fistulasrequiring more complex interventions.

O diagnosis and treatment should be carried out by a coloproctology specialist or proctology specialist. Here at Instituto Medicina em Foco, Dr. Carlos Obregon is ready to take an appropriate approach to each case. Early assessment is essential to avoid complications and provide the patient with a better recovery.

Make an appointment with a proctology specialist at Medicina em Foco and avoid complications from the pilonidal cyst.

What it is pilonidal diseaselearn about its concept

A pilonidal disease is an inflammatory condition that develops in the coccyx region, near the groove between the buttocks. It occurs when ingrown hairs penetrate the skin, forming a cyst or cavity that can become infected. This condition is more common in young men and in people who sit for long periods.

When not treated properly, it can develop into an abscess (accumulation of pus) or even form skin fistulas (small tunnels under the skin). Symptoms include pain, swelling and discharge and can cause significant discomfort in everyday life. coloproctology specialist through physical examination and, in some cases, imaging tests.

What is a pilonidal cyst??

O pilonidal cyst or sacrococcygeal cyst is an inflamed pouch that forms in the coccyx region, usually containing fluid, pus or ingrown hairs and arises when hairs penetrate the skin, causing an inflammatory reaction and, in many cases, infection. This condition is more common in men between the ages of 20 and 35, especially in people with excess hair or who spend long periods sitting down.

If left untreated, the cyst can develop into a pilonidal abscess (accumulation of pus) or form fistulas (tunnels under the skin) and, in some cases, a pilonidal sinusThis is a small tunnel under the skin that drains secretions. Symptoms include intense pain, redness and discharge.

Pilonidal disease symptoms

• Intense pain in the coccyx region, which worsens when sitting.
• Swelling and local redness, with a feeling of warmth in the affected area.
• Discharge of pus or blood (may have a bad smell).
• Palpable nodule or painful lump in the intergluteal fold.
• Fever (in cases of more serious infection).
• Fatigue and general malaise (when an infectious process is present).
• Formation of holes (sinuses) in the skin that drain secretion.
• Extreme sensitivity to touch in the affected area.

Attention: Symptoms can range from mild discomfort to incapacitating pain, depending on the stage of the disease. The presence of fever indicates infection and requires immediate medical attention.

Suspected pilonidal disease? Don’t put off treatment! Make an appointment with a coloproctology specialist in São Paulo.

Causes and risk factors of pilonidal disease

A pilonidal disease is often associated ingrown hairs that penetrate the skin of the sacrococcygeal region, causing inflammation. This condition can be aggravated by constant friction, prolonged pressure and excess humidity, which are common in people who sit for a long time or wear tight clothes. The combination of these factors favors infections and the development of pilonidal cyst.

Main causes of pilonidal disease

• Ingrown hairs: These penetrate the skin and cause an inflammatory reaction.
• Constant friction: friction in the coccyx region due to long periods of sitting or tight clothing.
• Excess moisture: sweat promotes bacterial proliferation.
• Local trauma: Injuries or intense pressure in the sacrococcygeal area.
• Favorable anatomy: Deep intergluteal groove that retains hair and debris.
• Bacterial infections: Commonly caused by Staphylococcus and anaerobic bacteria.
• Hormonal factors: increased activity of the sebaceous glands at puberty.

Risk factors

• Men between the ages of 20 and 35 (three times more affected than women).
• Excessive hair in the gluteal region.
• Sedentary professionals (drivers, clerks, call center operators).
• Obesity (BMI over 30).
• Family history of the condition.
• Military personnel and athletes who sit or use heavy equipment.
• Poor local hygiene.
• Frequent wearing of tight clothes.
• Excessive sweating in the gluteal region.

If you identify with one or more of these factors, it is important to consult a specialist in coloproctology for evaluation and prevention of complications.

Treatment for pilonidal cyst

O pilonidal cyst has several treatment optionsThese vary according to the severity of the case. For acute abscesses, the pilonidal cyst drainage is the most common initial procedure, performed under local anesthesia for immediate pain and infection relief. However, when not treated properly, the problem can become recurrent, requiring more definitive approaches.

Chronic or complex cases may require techniques such as marsupializationcomplete excision or minimally invasive procedures (EPSiT/LEPSiT). The choice of the best method depends on the assessment of a specialist considering factors such as the size of the cyst, the presence of fistulas and the patient’s history.

Non-surgical treatment

O he treatment of pilonidal cysts has a higher recurrence rate (30-50%) compared to surgical techniques and is mainly indicated for the first episodes, for patients with surgical contraindications and to prepare for definitive intervention.

• Abscess drainageoutpatient procedure under local anesthesia for immediate relief of pain and infection. Ideal for acute abscesses, but does not prevent recurrences.
• Phenol applicationChemical solution injected into the cyst to destroy the inflamed tissue. Effective in early cases, with a success rate of 60-80%.
• Antibiotic therapyThe use of antibiotics (clindamycin, metronidazole) to control associated infections. Treats the symptoms, but does not eliminate the cyst.
• Laser therapylaser hair removal to prevent new ingrown hairs. Reduces recurrences when combined with other treatments.
• Local careWarm compresses for spontaneous drainage, strict hygiene of the affected area and wearing loose-fitting cotton underwear.

Minimally invasive surgeries and techniques

Conventional techniques

• Excision with an open wound: complete removal of the cyst and allowing it to heal naturally, indicated for large or relapsed abscesses and longer recovery (4-8 weeks).
• Marsupialization: opening of the cyst and suturing of the edges to facilitate drainage, shorter healing time vs. open wound and recurrence rate of 10-20%.

Minimally invasive techniques:

• EPSiT (Endoscopic Pilonidal Sinus Treatment): use of microcamera for visualization and internal curettage, without external cuts – healing in 1-2 weeks and is ideal for cysts without acute abscesses.
• LEPSiT (Laser + EPSiT): combines endoscopy with laser to vaporize diseased tissue, reduces recurrences to <5% in selected cases and usually the patient is discharged the same day.

When to opt for minimally invasive techniques?

• Initial cases without large abscesses.
• Patients with relapses after conventional treatment.
• When you want to recover quickly (return to work in 3-5 days).
• To avoid extensive scarring.

Warning: It is contraindicated for very large abscesses (>5cm), multiple complex fistulas and severe uncontrolled infections.

Want to know which treatment option is best for you? Consult a proctology specialist and get a personalized assessment.

How can the sacrococcygeal cyst be prevented?

Cyst prevention should be based on simple habits that reduce its main risk factors. Although there is no method that guarantees total protection, maintaining strict hygiene, proper hair removal and avoiding prolonged pressure on the sacrococcygeal region significantly reduces the chances of developing the disease or suffering recurrences.

People with a family history of cyst or pilonidal abscessor who sit for long periods of time should take extra care and have their condition monitored by a coloproctology specialist.

Daily care to prevent recurrence

• Strict hygieneWash the area with neutral soap, dry well and avoid residual moisture.
• Regular hair removalremove hair from the gluteal region (machine or laser, never razor) every 2-3 weeks.
• Avoid prolonged pressuretake breaks every 1-2 hours if you work sitting down, using specific cushions.
• Suitable clothingprefer cotton garments and avoid tight clothes that increase friction.
• Weight controlKeep your BMI below 30 to reduce friction and sweating.
• Regular inspectioncheck the coccyx area for new ingrown hairs.

Attention: post-surgical patients should be followed up for 6 months, avoid prolonged sitting for the first 4 weeks and seek immediate care at the first sign of pain, discharge or skin fistulas.

When to see a proctology specialist?

The evaluation with Dr. Carlos Obregonis essential in the event of symptoms such as persistent pain, swelling, discharge or fever.

Cases of recurrent abscesses or fistula formation require rapid diagnosis and often surgical intervention. Regular monitoring is the best way to prevent complications and maintain the health of the area.

Make an appointment with a proctology specialist in SP.

Worried about pilonidal disease? Make an appointment with a specialist in coloproctology

In Instituto Medicina em Focoyou can find specialized treatment for pilonidal diseasewith the best protocols and modern techniques, such as EPSiT e marsupialization.

Our team of experts, including Dr. Carlos ObregonIn addition to a personalized, humanized service, we guarantee an accurate diagnosis and the most appropriate treatment for each case, whether in person or online. With a complete infrastructure and advanced technology, we provide comfort and efficiency from the very first assessment.

If you suffer from pain, abscesses or recurrences, don’t ignore the symptoms. A pilonidal disease can worsen without the right treatment, but with specialized care it is possible to achieve a definitive cure and regain your quality of life.

Book your appointment

If you have sacrococcygeal cystcyst, contact the MEF team and schedule an evaluation with a proctology specialist to determine the best treatment.

Make an appointment with Dr. Carlos Obregon and treat your pilonidal cyst.

Address of Instituto Medicina em FocoRua Frei Caneca 1380, Consolação, São Paulo, CEP 01307-000.

Opening hoursMonday to Friday, 8 a.m. to 9 p.m.

Phone: (11) 95675-6848

For more information, follow Instituto Medicina em Foco on social media:

• YouTube: Canal Medicina em Foco
• LinkedIn: Instituto Medicina em Foco
• Instagram: @emfoco.med.br
• TikTok: @emfoco.med.br
• Doctoralia: Instituto Medicina em Foco

Content updated in 2025.

FAQ: Frequently asked questions about pilonidal diseasecauses, symptoms and treatment options

1. What is a pilonidal abscess and how does it form?

O pilonidal abscess is the infection of the pilonidal cystcaused by the accumulation of hair and secretion in the sacrococcygeal region.

2. Is pilonidal sinus permanently cured or can it reappear?

O pilonidal sinus can be cured with proper treatment, but can reappear without hygiene care and prevention.

3. What are the main causes of pilonidal disease?

The causes of pilonidal disease include ingrown hairs, friction, excessive sweating and genetic predisposition.

4. How does pilonidal cyst drainage work?

In drainage the secretion is removed and the pain is relieved. The procedure can be carried out in a doctor’s surgery or in a hospital environment

5. When can treatment for pilonidal cysts be carried out using minimally invasive techniques?

Minimally invasive treatment is indicated in initial cases, evaluated by a proctology specialist.

6. Is the LEPSiT technique indicated for all cases of sacrococcygeal cyst?

The technique LEPSiT technique is indicated for selected cases of cyst based on a specialist’s assessment.

7. What is a pilonidal cyst and what are the early warning signs?

O pilonidal cyst is an inflammation near the coccyx; signs include pain, swelling, discharge and redness.

8. What are the symptoms of pilonidal disease?

Symptoms of pilonidal disease include pain, swelling, redness, discharge and, in severe cases, skin fistulas.

9. What does marsupialization mean when treating the disease?

A marsupialization is a surgery to treat pilonidal cystleaving the wound open for controlled healing.

10. When should we opt for open wound excision or techniques such as EPSiT to treat skin fistulas?

These techniques are indicated in complex cases of pilonidal disease with persistent fistulas.