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Treatments and drugs
By Mayo Clinic staffTreatment for an infected pilonidal cyst may include:
The initial treatment for an infected pilonidal cyst, or pilonidal abscess, is usually a procedure performed by your primary care doctor or a surgeon. You're given a local anesthetic to numb the area before your doctor opens the abscess, drains the fluids, and removes hair and other debris. The wound is packed with dressing so that it can heal from the inside out. For up to 60 percent of people with an infected pilonidal cyst, this treatment is effective and no further treatment is needed.
Surgery
A surgical procedure is necessary if you have a recurring infected pilonidal cyst or if one or more sinus tracts are present. A surgeon will expose the cysts and all sinus tracts in order to clean out hairs, pus and other debris. The preferred surgical procedures generally fall into two categories:
- Open wound. The surgical wound is left open and packed with dressing to allow it to heal from the inside out. This process results in a longer healing time but usually a lower risk of a recurring pilonidal cyst infection.
- Closed wound. After cleaning out the cyst and sinus tracts, the surgeon stitches the wound closed. The healing time is shorter with these procedures, but there is a greater risk of recurrence. To improve healing time and lower the risk of recurrence, the surgeon may make the incision off to one side and create a flap of skin. Therefore, when he or she stitches the wound, it is not in the cleft of the buttocks, where healing is particularly difficult.
Wound care is extremely important after surgery. Your doctor or nurse will give you detailed instructions on how to change dressings, what to expect of a normal healing process and when to call the doctor. Postoperative care will also include shaving around the surgical site to prevent hairs from entering the wound.
- Humphries AE, et al. Evaluation and management of pilonidal disease. The Surgical Clinics of North America. 2010;90:113.
- Sullivan DJ, et al. Pilonidal disease. http://www.uptodate.com/home/index.html. Accessed March 18, 2010.
- AL-Khamis A, et al. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database of Systematic Reviews. 2010:CD006213.
- Pilonidal disease. American Society of Colon and Rectal Surgeons. http://www.fascrs.org/patients/conditions/pilonidal_disease/. Accessed March 16, 2010.
- Bullard Dunn KM, et al. Colon, rectum and anus. In: Brunicardi FC, et al. Schwartz's Principles of Surgery. 9th ed. New York, N.Y.: The McGraw-Hill Companies; 2010. http://www.accessmedicine.com/content.aspx?aID=5015668&searchStr=pilonidal+cyst#5015668. Accessed March 17, 2010.
- Gibson LE (expert opinion). Mayo Clinic, Rochester, Minn. March 22, 2010.
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