A pimple or dimple. The only thing out of the ordinary with this particular pustule may be that it’s on your behind.
Sounds simple, routine even.
That is, until you discover that bump near your tailbone is a pilonidal cyst, known to be so painful when it abscesses that it weakens the knees of even the strongest.
Dr. Glen Morrell is something of a specialist in this discomfiting condition. But he’s refreshingly matter of fact. A pilonidal cyst, he says, is a chronic infec- tion at the top of the cleft between the buttocks. It occurs when a small opening in the skin appears, such as an enlarged pore, and becomes infected with bacteria, as well as skin and hair debris. Because that area of skin gets a lot of pressure — it’s that hard, bony area right over the tailbone — the infection goes inward.
Several factors may cause cysts
As for the initial cause, it could be many things. Perhaps a congenital defect (some babies are born with “pilonidal dimples” that may or may not flare up later on). Another factor may be what Dr. Morrell calls “patient habitus.” “Hygiene may play something of a role,” he said. “We tend to see pilonidal cysts in young Army recruits and (LDS) missionaries in third-world countries where hygiene is not as good.”
There may also be an age factor. “It seems to be a similar age as acne, so it may have something to do with oils in the skin.” And a gender factor. — it’s more common in men, perhaps because they simply have more hair follicles on their backsides.
- Age: check
- Gender: check
- Possible destination a third world country: check
That fits many an LDS missionary. The result is that Dr. Morrell works hand in hand with the LDS Church. “The missionary department of the LDS Church approached me about helping their missionaries,” he said. “It’s evolved over the last couple of years.”
Oh, and to counter an Internet rumor — a pilonidal cyst is not caused by bicycle riding, a common practice for missionaries. Nor it is caused by riding in a bumpy vehicle, a situation that led World War II soldiers to call this ailment the “Jeep disease”.
New ‘cleft lift’ procedure
Because the infection is chronic, the cyst weeps and seeps, causing discomfort and embarrassment. Antibiotics don’t seem to touch it, and “open healing” has its limitations.
For many years and continuing today, Dr. Morrell says, the traditional method was to simply remove the entire abscessed area — skin, fat, infection and all. Because it left a large cavity, recovery was long and painful, and in many cases the cyst reappeared.
Thank goodness for medical advances. Today, Dr. Morrell is one of a limited number of surgeons who perform a new surgery called a “cleft lift.” In this procedure, the “pimple” is removed by making a football-shaped incision perpendicular to the cleft (which we know better as the crack) and removing the problem area. The wound is then closed by suturing the skin flaps together. It’s called a “cleft lift” because the result is that the cleft is much reduced in size and shape — or lifted — reducing pressure and making the area less attractive to bacteria.
The older methods had a 30 to 50 percent chance of the cyst recurring, said Dr. Morrell. The cleft lift, by contrast, has about a 2 percent return rate. “Quite often we’ll initially treat it less invasively and let it heal,” he said, “and if it comes back we’ll do a more aggressive surgery.”
The cleft lift procedure also shortens the recovery time from the previous painful eight weeks, to about half that. “Within a month, patients are doing well,” he said. “In fact, within a week, things have healed up pretty well.”