Do chronic pilonidal cysts require treatment if there are no recurrent infections and they are draining well?

Management of Chronic Pilonidal Cysts Without Recurrent Infections

Chronic pilonidal cysts that are draining well without recurrent infections generally do not require immediate surgical intervention and can be managed conservatively with good hygiene practices.

Assessment of Pilonidal Cysts

When evaluating a chronic pilonidal cyst that is draining well without recurrent infections, consider:

• Duration of symptoms
• Location and extent of the cyst
• Quality of drainage
• Impact on patient's quality of life
• Previous treatment history

Management Approach

Conservative Management

For chronic pilonidal cysts that are:

• Draining well
• Not causing significant symptoms
• Without signs of infection
• Not enlarging

Conservative management is appropriate and includes:

1. Regular cleaning of the area

   • Daily showering with mild soap and water
   • Gentle drying of the area
   • Avoiding irritation to the area

2. Hair removal around the affected area

   • Regular shaving or depilatory creams
   • Prevents further hair penetration into the sinus tract
   • May help reduce recurrence risk 1

3. Maintaining good hygiene

   • Keeping the area clean and dry
   • Avoiding prolonged sitting
   • Using cushions to reduce pressure on the affected area

When Intervention Is Indicated

Intervention should be considered if the pilonidal cyst:

1. Becomes symptomatic (pain, discomfort affecting quality of life)
2. Shows signs of infection (erythema, increased pain, purulent discharge)
3. Enlarges significantly
4. Develops recurrent infections despite good hygiene 2

Treatment Options When Intervention Is Needed

If the cyst becomes problematic, treatment options include:

1. Incision and drainage

   • Recommended for inflamed cysts that become infected 2
   • Provides immediate relief of symptoms
   • May be followed by packing or left open to heal by secondary intention

2. Definitive surgical options (for recurrent or problematic cases)

   • Excision with primary closure
   • Excision with healing by secondary intention
   • Minimally invasive techniques

3. Adjunctive therapies

   • Laser hair removal has shown promise for recurrent cases 3
   • Post-surgical wound care with appropriate dressings 4

Follow-up Recommendations

For patients managing chronic pilonidal cysts conservatively:

• Regular self-monitoring for signs of infection
• Prompt medical attention if symptoms worsen
• Periodic evaluation by healthcare provider

Conclusion

The evidence supports that chronic pilonidal cysts that are draining well without recurrent infections can be managed conservatively with good hygiene practices. Surgical intervention should be reserved for cases that become symptomatic, infected, or significantly impact quality of life.

The conservative approach is supported by the understanding that pilonidal disease is acquired rather than congenital, with hair being the primary causative agent 1. By maintaining good hygiene and preventing further hair penetration, many patients can successfully manage their condition without surgical intervention.