If you have hidradenitis suppurativa (HS), you may also have experienced or are experiencing a pilonidal cyst.

HS is a skin condition that causes painful boil-like, abscesses, and tunnels that can occur anywhere on your body where there is a hair follicle. Research has shown that if you have HS, you may be more likely to develop pilonidal cysts. Pilonidal cysts are painful, fluid-filled sacs that are usually found near the tailbone (typically at the top of the butt crack). 

Why do people with HS have a Higher Risk of Pilonidal Cysts?

The exact reasons are unknown, but several factors may play a role. Both HS and pilonidal cysts are prone to form in high-friction areas, leading to trapped hair and bacteria growth. The chronic inflammation caused by HS can also weaken the skin’s barrier and make you more susceptible to cysts and other infections. Risk factors like smoking and obesity are shared between both HS and pilonidal cysts, although these risk factors are not the cause of either condition. Under the microscope, pilonidal cysts and HS also have similar characteristics. This has led some experts to believe that pilonidal cysts may be a localized form of HS.

Symptoms of Pilonidal Cysts

The main symptom of pilonidal cysts is pain at the tailbone, especially when sitting. Sometimes pilonidal cysts can become infected, and you might notice swelling, redness, drainage, or fever, which are similar symptoms to what most of us experience with HS. However, many pilonidal cysts, especially early-stage or non-infected ones, may not have any symptoms at all. If you have HS and are experiencing symptoms of pilonidal cysts, it is important to speak to a dermatologist who is familiar with managing both conditions. 

Pilonidal Cysts Treatment Approaches 

Here are some things you may want to consider to prevent and manage pilonidal cysts (please note that this is not an exhaustive list and just like with HS, what works for one may not work for another):

  1. Wearing loose and breathable fabrics, particularly pants, to reduce friction in areas prone to pilonidal cyst formation
  2. Gently exfoliate and use mild soaps between the buttocks. We recommend using CLn BodyWash (can be used daily) or Hibiclens (use no more than 3 times per week)!
  3. Laser hair removal may help to prevent pilonidal cysts from coming back. Learn more about laser hair removal here.
  4. From a medication management perspective, treatment for HS, especially biologics, can also help with pilonidal cysts.
  5. Draining might be needed if the pilonidal cysts become infected or are extremely painful. It is important to keep in mind that incision and drainage procedures have a 100% recurrence rate and should not be done unless medically necessary. Repeated incision and drainage procedures can cause extra scar tissue to form, which might make other, more effective surgeries harder to perform. This is true for both HS lesions and pilonidal cysts. 
  6. Cleft Lift Surgical Procedure is a surgical procedure that removes pilonidal cysts and flattens the buttock crease. It’s usually performed as an outpatient procedure under general anesthesia and is associated with high rates of healing and low recurrence rates. 

Dealing with HS and pilonidal cysts can take a lot of patience and perseverance, and having a strong support system is crucial to your disease management and overall well being. Please check out our support page here for additional resources.

References

  1. Ureña-Paniego C, Gamissans-Cañada M, Molina-Leyva A, Romaní J. Pilonidal Sinus Disease is Associated with Severe Hidradenitis Suppurativa in a Spanish Cohort. Acta Derm Venereol. 2023;103:adv6569. doi: 10.2340/actadv.v103.6569. 

Written by Grace Xiong, Medical Student Class of 2026, McMaster University

Edited by Brindley Brooks

Medically reviewed by Adam Friedman

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