Pilonidal abscess

Pilonidal abscess

A Pilonidal abscess is a type of abscess that typically occurs in the cleft at the top of the buttocks. The term "pilonidal" comes from the Latin words pilus, meaning hair, and nidus, meaning nest, which reflects the common finding of hair within the cyst. Pilonidal abscesses are a form of skin and soft tissue infection and are considered a type of pilonidal disease, which can range from asymptomatic hair-containing cysts to painful infections.

Causes and Risk Factors

Pilonidal abscesses are believed to be caused by the penetration of loose hairs into the skin. Friction and pressure, such as that from prolonged sitting, tight clothing, or activities like cycling, can drive hair into the skin layers, leading to irritation, infection, and eventually abscess formation. Other risk factors include being male, young adulthood, obesity, excessive body hair, and a sedentary lifestyle.

Symptoms

The primary symptom of a pilonidal abscess is pain at the bottom of the spine, which can worsen when sitting or standing. The area may also be red, swollen, and warm to the touch. Pus or blood draining from an opening in the skin is another common symptom, often accompanied by a foul odor. Fever may occur if the infection is severe.

Diagnosis

Diagnosis of a pilonidal abscess is primarily based on the physical examination of the area. In some cases, imaging tests such as ultrasound or MRI may be used to assess the extent of the infection or to rule out other conditions.

Treatment

Treatment options for a pilonidal abscess include incision and drainage, which involves cutting open the abscess to allow the pus to drain. This procedure is typically performed under local anesthesia. After drainage, the area may be packed with gauze to keep it open and allow for continued drainage while it heals. In cases where abscesses recur or develop into complex pilonidal disease, more extensive surgical options may be considered. Antibiotics are not usually required unless there is evidence of a spreading infection.

Prevention

Preventive measures for pilonidal abscesses focus on reducing friction and pressure on the area. This can include using a cushion when sitting for long periods, maintaining good hygiene, and keeping the area clean and dry. Regular hair removal in the area, through shaving or laser hair removal, may also reduce the risk of developing a pilonidal abscess, although evidence on the effectiveness of this approach is mixed.

Complications

If left untreated, a pilonidal abscess can lead to several complications, including recurrent infections, the formation of sinus tracts, or the development of a chronic pilonidal cyst. Rarely, a long-standing pilonidal disease may increase the risk of developing squamous cell carcinoma, a type of skin cancer.

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