From the Research
The most effective management option for pilonidal cysts is aspiration followed by antibiotics for acute pilonidal abscesses, with a success rate of 83% and high patient satisfaction, as supported by the most recent and highest quality study 1.
Management Options
Management options for pilonidal cysts include both conservative and surgical approaches depending on severity. For mild cases, conservative management involves:
- Keeping the area clean with regular washing using mild soap and water
- Hair removal around the affected area through shaving or laser treatment
- Avoiding prolonged sitting Acute infections can be treated with oral antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days) or trimethoprim-sulfamethoxazole (160/800 mg twice daily for 7-10 days).
Surgical Intervention
For abscesses, incision and drainage may be necessary for immediate relief, performed under local anesthesia with a small incision to evacuate pus. Definitive treatment often requires surgical intervention, with options including:
- Excision with primary closure
- Excision with healing by secondary intention
- Minimally invasive techniques like pit picking or endoscopic treatment Recurrence rates vary by procedure, with wide excision having lower recurrence but longer healing times.
Post-Operative Care
Post-operative care includes:
- Keeping the wound clean
- Following dressing change instructions
- Continuing hair removal to prevent recurrence The choice of management depends on factors such as symptom severity, recurrence history, and patient preferences, as discussed in 2, 3, 4, 5. However, the most recent and highest quality study 1 supports aspiration followed by antibiotics as the most effective management option for acute pilonidal abscesses.