From the Research
Most pilonidal abscesses require drainage for definitive treatment, but recent evidence suggests that needle aspiration with antibiotics may be a suitable alternative in some cases. When a pilonidal abscess becomes infected and forms a collection of pus, incision and drainage is typically necessary to relieve pain, prevent further spread of infection, and promote healing. This procedure involves making a small incision to allow the pus to drain, followed by packing the wound to allow healing from the inside out. After drainage, patients should keep the area clean with regular showering, and may need to change packing material as directed by their healthcare provider.
- The use of ultrasonography can be valuable in diagnosing abscesses that are not clinically evident and in guiding incision and drainage (I&D) procedures 1.
- Antibiotics alone are generally insufficient for treating an established abscess, though they may be prescribed alongside drainage if there is surrounding cellulitis or if the patient has certain risk factors.
- In rare cases, very small or early abscesses might resolve with antibiotics and warm compresses, but this is uncommon.
- The need for drainage is based on the body's inability to clear the infected material on its own once an abscess cavity has formed.
- Without drainage, the infection typically worsens, causing increased pain and potentially spreading to surrounding tissues.
- After the acute infection resolves, patients should be aware that pilonidal disease often recurs, and definitive surgical treatment might be recommended to prevent future episodes.
- A recent study found that aspiration and antibiotic management of pilonidal abscess is effective in 95% of acute cases in preventing the need for emergent laying open and allows for subsequent elective surgery 2.
- Another study suggested that endoscopic pilonidal abscess treatment (EPAT) is a novel, minimally invasive technique for the treatment of acute pilonidal abscesses, associated with reduced postoperative morbidity, recurrence rate, and quick wound healing 3.