From the Guidelines
Management of a pilonidal cyst typically begins with incision and drainage for acute, infected cases, followed by daily wound packing and regular cleaning, with surgical intervention for more severe or recurrent cases. The initial treatment for an infected pilonidal cyst involves making a small incision to release pus and debris, which is a crucial step in managing the infection, as noted in the guidelines for the diagnosis and management of skin and soft-tissue infections 1. This approach is supported by the understanding that effective treatment of abscesses and inflamed epidermoid cysts entails incision, thorough evacuation of the pus, and probing the cavity to break up loculations 1.
For mild cases, conservative measures such as maintaining good hygiene, avoiding prolonged sitting, and regular hair removal from the affected area can be sufficient. However, for more severe cases or those that recur, definitive surgical treatment is recommended. Options for surgical treatment include:
- Excision with primary closure
- Excision with healing by secondary intention
- Advanced techniques like the Karydakis flap or Limberg flap procedures
Post-operative care is crucial and involves keeping the area clean and dry, regular dressing changes, and hair removal from the sacrococcygeal area through shaving or laser hair removal to prevent recurrence. Antibiotics may be prescribed if there are signs of surrounding cellulitis or systemic infection, but their use should be judicious and based on clinical judgment, as they are rarely necessary for the treatment of abscesses and inflamed epidermoid cysts 1. Preventive measures, including weight management and avoiding activities that exacerbate the condition, are also fundamental to the long-term management of pilonidal disease.
From the Research
Management of Pilonidal Cysts
The management of pilonidal cysts involves various treatment options, including:
- Surgical intervention, which is the preferred first line treatment 2, 3, 4, 5
- Postsurgical wound care, which may include rinsing with clean water, dressing with a sterile compress, and the use of haemoglobin spray 2
- Incision and curettage, which is a surgical procedure that involves making an incision and scraping out the infected tissue 3
- Excision of the cyst, with open or closed wound for healing 3
- Use of antibiotic therapy, which may be used to treat infections and prevent recurrence 4, 5
- Laser and light treatments, which have been shown to be effective in reducing recurrence rates 6
Treatment Outcomes
The outcomes of these treatment options vary, but studies have shown that:
- Complete wound closure can be achieved in an average of 76 days with appropriate wound care 2
- Incision and curettage can result in low morbidity, fast healing, and low recurrence rates 3
- Excision of the cyst can result in high recurrence rates, especially in patients with hirsutism 3
- Laser and light treatments can provide longer disease-free intervals and fewer recurrences 6
Alternative Treatments
Alternative treatments, such as: