What is the treatment for a 1.5 cm infected pilonidal cyst?

Treatment of a 1.5 cm Infected Pilonidal Cyst

The definitive treatment for a 1.5 cm infected pilonidal cyst is incision and drainage, which should be performed promptly to evacuate the pus and relieve symptoms. 1

Initial Management

Surgical Approach

• Incision and drainage is the cornerstone of treatment for an infected pilonidal cyst
• The procedure involves:
  • Making an incision over the fluctuant area
  • Thorough evacuation of all purulent material
  • Breaking up any loculations within the abscess cavity
  • Exploring for and removing any hair follicles or foreign material

Post-Procedure Care

• Simple covering of the surgical site with a dry dressing is usually sufficient
• Some clinicians may pack the wound with gauze, though this is not always necessary
• Daily dressing changes until the wound heals by secondary intention

Antibiotic Therapy

Antibiotics are generally not required for uncomplicated pilonidal abscesses after adequate drainage unless:

• Patient has systemic signs of infection (fever >38°C, tachycardia >90 beats/min, tachypnea >24 breaths/min, or abnormal white blood cell count) 1
• Extensive surrounding cellulitis is present
• Patient has significant comorbidities or immunocompromise

If antibiotics are indicated, they should cover:

• Staphylococcus aureus (including MRSA consideration if risk factors present)
• Skin flora and anaerobes

Follow-Up Care

After resolution of the acute infection:

• Search for local causes of recurrence such as persistent pilonidal sinus 1
• Consider definitive surgical treatment to prevent recurrence
• Maintain good local hygiene to reduce risk of reinfection

Prevention of Recurrence

Pilonidal cysts have a high rate of recurrence. Preventive measures include:

• Regular cleaning of the affected area
• Hair removal (shaving or laser) of the area
• Weight loss if applicable
• Avoiding prolonged sitting

Common Pitfalls

1. Inadequate drainage: Failure to break up all loculations or completely evacuate the abscess can lead to persistent infection
2. Missing foreign material: Hair follicles or other debris must be removed to prevent recurrence
3. Overuse of antibiotics: Antibiotics alone without drainage are ineffective for abscess treatment
4. Delayed definitive treatment: Recurrent infections are common without addressing the underlying pilonidal disease

Pilonidal disease is considered an acquired condition in most cases, with hair being the primary causative agent. While the initial treatment focuses on addressing the acute infection through drainage, definitive surgical management may be necessary for patients with recurrent disease.