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A 33 year-old over-the-road truck driver had a tender, inflamed cyst above his gluteal cleft. It ruptured and blood and pus came out and it has been draining, intermittently, for the past 2 years. He said his father and brother had similar lesions that required surgical removal.
What’s your diagnosis? 
Diagnosis:
Pilonidal Cyst
A pilonidal cyst or sinus is an abnormal area or sack in the skin that usually contains dead skin, oil and debris. A pilonidal cyst is commonly situated near the bottom of the spine near or at upper cleft of the buttocks.
The exact cause of a pilonidal cyst is uncertain, but it is associated with pressure in the area such as tight clothing or prolonged sitting. One theory proposes the pressure on and rubbing around of an area of excess hair or ingrown hairs in the skin causes a cyst to be formed around it that only increases in severity over time and with continued pressure. Another theory proposes there is a natural weakness in the area, and prolonged pressure or rubbing or friction can cause a pocket to form that becomes a cyst.
Pilonidal cysts commonly occur in young men. The cysts may go away, but they often recur. People who sit for prolonged periods of time, such as car, bus and truck drivers, are at an increased risk of developing pilonidal sinus disease, as are those who are obese and inactive.
A pilonidal cyst can become enlarged, inflamed, red, swollen, and extremely painful (abscessed). The area may rupture and drain through a small opening, producing pus, blood, or a foul-smelling drainage. The drainage may become a recurrent problem.
Treatment
Prescription antibiotics may be employed to treat any associated infection. The intact cyst can be drained through a small incision. If the area is chronically problematic, the best treatment is to have the area removed surgically. The surgical treatment of a pilonidal cyst is a complicated affair and can best be discussed with your surgeon. Some physicians believe that if a chronically infected pilonidal cyst is not removed surgically, there may be a slightly increased chance of developing squamous cell skin cancer in the area.
Prevention
Because pilonidal sinus disease is associated with obesity, inactivity, prolonged sitting and poor hygiene, avoidance of any or all of these factors is recommended.
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