From the Research
Management of pilonidal cysts in Australia typically follows a stepwise approach based on severity, with the most recent and highest quality study 1 suggesting that chronic pilonidal disease can be effectively managed with a combination of conservative and surgical treatments. For mild cases, conservative management includes:
- Regular hair removal around the affected area
- Maintaining good hygiene with daily showers
- Avoiding prolonged sitting Acute infections require antibiotics such as Augmentin (amoxicillin with clavulanic acid) 875/125mg twice daily for 5-7 days, or clindamycin 300mg four times daily for patients with penicillin allergy, as supported by the study 2. Painful abscesses need incision and drainage under local anesthesia, followed by packing and regular dressing changes. For recurrent or chronic pilonidal disease, definitive surgical treatment is recommended, with the study 3 showing that minimal excision under local anesthesia with healing by secondary intention can be an effective treatment option. The most common procedures in Australia include:
- Wide excision with secondary healing
- Excision with primary closure
- Minimally invasive techniques like pit picking or endoscopic treatment The Bascom procedure (lateral approach) and Karydakis flap are increasingly popular as they have lower recurrence rates and faster healing times, as mentioned in the study 1. Post-operative care includes:
- Regular wound cleaning
- Dressing changes
- Follow-up appointments To prevent recurrence, patients should continue:
- Regular hair removal (by shaving, laser, or depilatory creams)
- Maintaining good hygiene
- Avoiding prolonged sitting
- Considering using cushions to reduce pressure on the sacrococcygeal area Pilonidal disease occurs due to hair penetrating the skin in the natal cleft, causing inflammation and subsequent infection, which explains why proper hair management is crucial to treatment success, as highlighted in the study 4.