From the Research
Treatment for pilonidal cysts should prioritize surgical excision with primary midline closure and the use of closed incision negative pressure therapy to reduce morbidity, mortality, and improve quality of life. This approach is supported by the most recent and highest quality study available, which compared primary midline closure with and without closed incision negative pressure therapy after pilonidal cyst excision 1. The study found that the use of closed incision negative pressure therapy resulted in shorter hospital stays, reduced pain, and faster healing times.
Conservative Management
For mild cases, conservative management may be sufficient, including:
- Keeping the area clean and dry
- Regular hair removal around the affected area
- Warm sitz baths 2-3 times daily for 10-15 minutes to help reduce inflammation and promote drainage
- Over-the-counter pain medications like acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) to manage discomfort
Surgical Intervention
More severe or recurrent cases require surgical intervention, which may include:
- Incision and drainage for acute abscesses
- Excision with either open healing, primary closure, or flap techniques for chronic cases
- The use of closed incision negative pressure therapy to promote healing and reduce complications
Long-term Prevention
Long-term prevention involves:
- Maintaining good hygiene
- Avoiding prolonged sitting
- Regular hair removal in the area
- Weight management
- These treatments address the fundamental issue of hair follicles becoming embedded in the skin, creating inflamed tracts that can become infected in the sacrococcygeal region, as discussed in 2 and 3.
Key Considerations
- The use of local and systemic retinoids, such as isotretinoin, may be beneficial in the treatment of pilonidal cysts, as suggested in 2.
- The choice of surgical technique depends on the severity of the disease and the surgeon's preferences, as noted in 4 and 5.
- Proper wound care, including regular dressing changes and keeping the area clean, is essential for promoting healing and reducing complications, as emphasized in 1.