Pilonidal cysts affect roughly 26 out of every 100,000 people in Western populations each year, translating to about 70,000 cases annually in the United States alone. While that makes them relatively uncommon in the general population, they’re surprisingly concentrated among specific groups, particularly young adults, men, and people in certain occupations.
Who Gets Pilonidal Cysts Most Often
Pilonidal disease overwhelmingly strikes teenagers and young adults, with peak incidence in the second and third decades of life. In a study of over 1,300 patients, about 59% were male and 41% were female. The timing of onset differs between sexes: girls tend to develop the condition around age 14.8 on average, while boys typically present about two years later, around age 16.9. After age 40, new cases drop off significantly.
The condition is more common in people with coarse or thick body hair, particularly in the gluteal cleft area. Deeper natal clefts, which trap more moisture and debris, also increase susceptibility. If you fall into the peak demographic (a young man with thick body hair), pilonidal cysts are far more common in your peer group than the general population numbers suggest.
Body Weight and Sitting Play a Role
Higher body weight is one of the strongest predictors of both developing and re-developing pilonidal disease. In one study, patients with a first-time pilonidal cyst had an average BMI of about 26.5, just into the overweight range. But patients whose cysts came back had an average BMI of 32, well into obesity. Among those with recurrent disease, roughly 69% had a BMI above 30. Extra weight increases pressure on the tailbone area and deepens the skin fold where hair and debris collect.
Prolonged sitting compounds the problem. The condition earned the nickname “jeep disease” during World War II because it appeared so frequently among soldiers who spent long hours bouncing in jeep seats. The combination of constant pressure, friction, and vibration against the sacral skin was enough to drive loose hair into follicles and trigger the inflammatory process that creates a cyst. That same mechanism applies today to truck drivers, office workers, and anyone who sits for extended periods on a regular basis.
Occupations With Higher Risk
Truck drivers and other professional drivers face elevated risk due to the hours spent sitting with repeated low-grade trauma to the tailbone area. But driving isn’t the only occupational hazard. Barbers, hairdressers, sheep shearers, and dairy milkers also see higher rates, though for a different reason: loose hair and wool fibers can work their way into the skin between fingers or near the tailbone, sparking the same foreign-body reaction. For drivers, the mechanism is friction and pressure. For hairdressers, it’s exposure to cut hair that embeds itself in skin.
How Often Pilonidal Cysts Come Back
One of the most frustrating aspects of pilonidal disease is its tendency to recur. Recurrence rates vary widely depending on how the cyst is treated. After surgical removal with the wound left open to heal on its own (a common approach), recurrence falls in the range of 9% to 27%. More advanced flap-based surgical techniques can reduce that number, but no method eliminates the risk entirely.
For people managed without surgery, the picture is worse. Recurrence rates for nonsurgical management can reach as high as 55%, and even among those who do have an operation, rates between 30% and 40% have been reported in adolescent and young adult populations. Younger patients and those with higher BMIs face the greatest odds of seeing their cyst return, which means the very group most likely to get a pilonidal cyst in the first place is also the group most likely to deal with it repeatedly.
What a Pilonidal Cyst Looks and Feels Like
The hallmark sign is one or more small pits along the midline of the gluteal cleft, near the tailbone. These pits connect to tunnels beneath the skin that usually run upward toward the lower back, though some extend downward and can be mistaken for other conditions. In the acute phase, you might notice a painful, swollen lump that feels warm to the touch, sometimes with redness spreading outward. This signals an abscess forming beneath the skin.
In its chronic form, the cyst becomes a draining sinus that intermittently leaks fluid or pus. Some people cycle between flare-ups and quiet periods for months or years. The diagnosis is typically made based on the location and appearance alone, without imaging or lab tests. If you have a tender bump or persistent drainage near your tailbone, especially if you’re in your teens or twenties, pilonidal disease is one of the most likely explanations.
Rising Rates in Young People
While the overall incidence of 26 per 100,000 has remained a commonly cited benchmark, several factors suggest the condition may be affecting more young people than it did a generation ago. Rising rates of adolescent obesity, increasingly sedentary lifestyles centered on screen time, and more time spent sitting in school and at desks all align with known risk factors. The concentration of cases in teenagers and young adults means that even modest shifts in weight and activity patterns in this age group can meaningfully change how many people end up dealing with pilonidal disease.