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Pilonidal Cyst and Sinus Nursing Guide

This course provides a concise reference for pilonidal cyst and sinus, covering an overview and nursing considerations using the nursing process.

Content reviewed by Ann Dietrich, MD, FAAP, FACEP. 

Pilonidal Cyst and Sinus Etiology and Epidemiology 

Pilonidal disease is a skin condition historically seen as congenital but now thought to be acquired (Johnson, 2021). It commonly affects the gluteal cleft but can also occur in the umbilicus and interdigital spaces. The exact cause is unknown, though repetitive movements, such as prolonged sitting and bending, are believed to contribute by breaking hair follicles and stretching the overlying skin. This can lead to the formation of a pilonidal sinus, which may progress to a cyst and potentially to an acute or chronic abscess. 

Pilonidal disease typically presents between the ages of 15 and 30 and is more prevalent in males (DynaMed, 2018). Risk factors include: 

  • Obesity 
  • Hairiness 
  • Male gender 
  • Poor hygiene 
  • Deep gluteal cleft 
  • Trauma or irritation 
  • Family history 
  • Characteristics of an individual's hair 
  • Excessive hair growth (hirsute habitus) 
  • Prolonged sitting with poor posture 

Pilonidal Cyst ICD-10 Code

L05.91 - Pilonidal cyst without abscess 

Clinical Presentation 

Pilonidal disease can lead to acute or chronic subcutaneous abscesses. Symptoms of acute pilonidal abscess include: 

  • Pain 
  • Swelling 
  • Erythema 
  • Tenderness 
  • Fever and malaise (if undrained) 

Chronic disease may involve recurrent infections and spontaneous drainage. Although the prognosis is good with low mortality, the disease is associated with significant morbidity and recurrence in 50% of cases (DynaMed, 2018). 

Complications 

  • Abscess 
  • Cellulitis 
  • Recurrence 
  • Systemic infection 
  • Squamous cell carcinoma 
  • Pain (moderate to severe if abscessed) 

Pilonidal Cyst and Sinus Diagnosis 

Diagnosis is primarily clinical, based on physical findings (DynaMed, 2018). Differential diagnoses include hidradenitis suppurativa, folliculitis, and perianal abscess. Imaging, though not usually necessary, can delineate the extent of the sinus tract and help in surgical planning. Common imaging studies include ultrasonography and MRI. 

Management 

Treatment varies depending on the extent and severity of symptoms. Asymptomatic cases may not require treatment, while abscessed cysts necessitate drainage (DynaMed, 2018). Pain management includes analgesics and NSAIDs. Phenol injections can aid healing in non-abscessed cases (Johnson et al., 2019). 

Surgical options include: 

  • Pilonidal cystectomy 
  • Incision and drainage 
  • Unroofing and curettage 
  • Hair removal (shaving or laser epilation) 
  • Marsupialization 
  • Primary closure (higher recurrence risk) 

Pilonidal Cyst and Sinus Nursing Care Plan 

Assessment 

Gather a medical history, including: 

  • Fever 
  • Risk factors 
  • Lower back pain 
  • Prolonged symptoms 
  • Previous cysts or abscesses 

Conduct a physical examination to check for: 

  • Pain 
  • Warmth 
  • Swelling 
  • Erythema 
  • Tenderness 
  • Tuft of hair 
  • Cellulitis 
  • Sacrococcygeal mass 
  • Presence of cyst or abscess 
  • Infection signs 
  • Sinus tract with purulent discharge 

Nursing Diagnoses 

  • Risk for acute pain related to cyst or abscess 
  • Risk for disturbed body image due to sacrococcygeal mass 
  • Risk for impaired tissue integrity due to cellulitis 
  • Risk for infection due to blocked hair follicle 

Interventions 

  • Preoperative and postoperative care 
  • Assist with hygiene of affected area 
  • Administer prescribed medications 
  • Position patient to avoid tailbone pressure 
  • Educate on prevention and proper wound care 
  • Monitor pain, wound healing, and infection signs 

Expected Outcomes 

  • No further signs of infection 
  • Reduced or absence of pain 
  • Improved or healed tissue integrity 
  • Resumption of normal activities without pain 
  • Effective coping with body image changes 

Patient/Caregiver Education 

  • Explain the condition, diagnosis, and treatment options 
  • Medications and side effects 
  • Importance of reporting recurrent symptoms 
  • Dressing change techniques for postoperative care 
  • Completing the full course of antibiotics when indicated 
  • Use of sitz baths for comfort 
  • Preventive measures for recurrence

FAQs

Additional Information

Content Release Date 

3/31/2022

Content Expiration

12/31/2026

References 

  • DynaMed. (2018). Pilonidal disease. EBSCO Information Services. 
  • Johnson, E. (2021). Pilonidal disease. UpToDate.
  • Johnson, E., Vogel, J., Cowan, M., Feingold, D., & Steele, S. (2019). The American Society of Colon and Rectal Surgeons’ clinical practice guidelines for the management of pilonidal disease. Diseases of the Colon & Rectum, 62(2), 146-157.
  • Nixon, A., & Garza, R. (2021). Pilonidal cyst and sinus. StatPearls Publishing.
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