Treatment of Pilonidal Cysts

The recommended treatment for pilonidal cysts is incision and drainage, which should be performed for all inflamed pilonidal cysts. 1

Surgical Management

Incision and drainage is the primary treatment for inflamed pilonidal cysts, allowing for thorough evacuation of pus and probing of the cavity to break up loculations 1
For recurrent abscesses at a site of previous infection, search for local causes such as a pilonidal cyst, which should be drained and cultured early in the course of infection 1
Complete surgical excision of the cyst is often performed after the acute inflammation has resolved to prevent recurrence 2
After surgical drainage, the wound can be managed in one of two ways:
- Open wound healing (secondary intention) - simply covering the surgical site with a dry dressing 1
- Closed wound healing (primary closure) - suturing the wound closed 1, 2

Appropriate wound care after surgical intervention is crucial to prevent healing disturbances 3
Recommended post-surgical wound care includes:
- Rinsing the wound with clean water or antimicrobial solution 3
- Applying sterile dressings 3
- Regular wound assessment and appropriate debridement as needed 3

Systemic antibiotics are generally unnecessary for uncomplicated pilonidal cysts after incision and drainage unless there is extensive surrounding cellulitis or systemic signs of infection 1
For recurrent pilonidal abscesses, a 5-10 day course of antibiotics active against the cultured pathogen may be considered 1

Recurrence rates for pilonidal cysts can be high (15-30%), particularly in hirsute individuals 2, 4
For recurrent cases, more definitive surgical approaches may be necessary:
- Complete excision of the cyst and sinus tracts 2
- Various surgical techniques including marsupialization, flap procedures, or minimally invasive approaches 2
Adjunctive measures to prevent recurrence:
- Hair removal in the affected area (shaving, depilatory creams) 5
- Laser hair removal or intense pulsed light (IPL) therapy has shown promise in preventing recurrence by reducing hair in the natal cleft 4

Chronic, long-standing pilonidal disease with recurrent inflammation has a rare but serious risk of malignant transformation to squamous cell carcinoma 6
Patients with recurrent disease should be monitored for any unusual changes in appearance or growth of the lesion 6

Inadequate drainage and incomplete removal of hair and debris from the sinus tract can lead to recurrence 2
Overly aggressive surgical excision can lead to prolonged healing time and increased patient discomfort 2
Failure to address predisposing factors (excessive hair, deep natal cleft, obesity) may contribute to recurrence 2, 4
Wound healing complications are common after surgical treatment and require appropriate wound care to prevent infection and promote healing 3