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If you have a sore bump near your tailbone (the coccyx bone) that looks like a big pimple, you probably have a pilonidal cyst. If it is inflamed and infected with pus draining from it, then it is a pilonidal abscess.

The tailbone is the end of the spine located above the crack of your buttocks. Some people, especially men, have hair growing in this part of the body. Some experts believe that when the hair grows inward and becomes embedded into the skin of this area, a pilonidal (hair nest) cyst develops. Because this area is near the anus, it can easily become infected and form an abscess. A pilonidal sinus, or a tract that extends deeper into the skin may also develop.

Although the cause of this is not very clear, some people are more likely to develop pilonidal cysts, including obese men, those who have a lot of body hair, have poor hygiene, and those who sit for long periods, wear tight clothes, or experience repeated trauma in this part of the body. These are also common between the ages of 20 to 40 years.

Some people may not experience any symptoms related to the pilonidal cyst, while others may feel some tenderness if it is inflamed. Infection can result in fever and pain. Recurrence is common.

Rare complications include spread of infection to the tissues, causing cellulitis (infection of deeper tissues), systemic infection, which affects the whole body, and development of cancer (squamous cell carcinoma).

Treatment

A doctor may be able to diagnose a pilonidal cyst or abscess just by taking your medical history and doing a physical examination. No special tests are necessary. If you do not have any symptoms, there is no need for treatment. You may be advised to use a hot sitz bath to relieve discomfort until the cyst becomes smaller in size.

However, if it is infected and inflamed, the doctor may make a skin incision after applying a local anesthetic and drain the pus. He may leave the surgical wound open and pack it with a sterile gauze or close the wound with stitches. Leaving it open may delay wound closure, but it has the advantage of having less chance for recurrence. This minor surgical procedure is done as an outpatient basis, but wound care at home is important. Pain medications may be prescribed, but antibiotics are not always necessary. If the abscess is large and the wound area is wide, skin grafting may be needed to cover the exposed area. To avoid recurrences, gentle removal of hair around the area and personal hygiene must be observed.

Prevention

To prevent pilonidal cysts and abscesses from developing, doctors recommend keeping the lower back area clean and dry, removing excess hair by shaving, using depilatory creams, applying electrolysis or laser hair removal techniques. Obese individuals may benefit from losing weight and avoiding sitting for long periods to avoid trauma in this area and to reduce recurrences.

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