Treatment Options for Pilonidal Cysts

Incision and drainage is the primary treatment for inflamed pilonidal cysts, followed by appropriate wound management to prevent recurrence. 1

Initial Management of Acute Pilonidal Cysts

Incision and drainage is the first-line treatment for inflamed pilonidal cysts, allowing thorough evacuation of pus and probing of the cavity to break up loculations 1
After surgical drainage, the wound can be managed in two ways:
- Open wound healing (secondary intention): covering the surgical site with a dry dressing 1
- Closed wound healing (primary closure): suturing the wound closed 1
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 abscesses, search for local causes such as a pilonidal cyst, which should be drained and cultured early in the course of infection 1
A 5-10 day course of antibiotics active against the cultured pathogen may be considered for recurrent pilonidal abscesses 1
Definitive surgical treatment is often necessary for recurrent cases, with several techniques available:
- Traditional excision (with either open or closed healing) 2
- Incision and curettage (considered by some to have better outcomes regarding morbidity, healing time, and recurrence rates) 2

Laser hair removal using Nd-YAG laser has shown promising results for recurrent pilonidal cysts:
- In a study of 10 patients, all became asymptomatic after 2-4 treatments 3
- Complete clinical resolution was achieved after 4-8 sessions with no recurrence during follow-up 3
- This approach avoids the complications and recovery time associated with surgery 3
Intense pulsed light (IPL) therapy has also been reported as an alternative treatment:
- In a small case series, patients remained recurrence-free for periods of 7 to over 36 months 4
- These technologies may provide longer disease-free intervals compared to traditional surgical interventions 4

Proper wound care after surgical intervention is crucial for optimal healing 5
An effective wound care regimen includes:
- Appropriate mechanical or autolytic debridement 5
- Rinsing with antimicrobial solution 5
- Application of appropriate dressings 5
With adequate wound care, complete closure can typically be achieved within 2-3 months 5

Incisions that cross the vertical gluteal fold at an angle (rather than placing the suture line directly in the gluteal fold) have shown better healing outcomes 6
This approach resulted in primary union and complete healing within six weeks in 89% of cases in one study 6

Failure to adequately drain all loculations during the initial procedure can lead to persistent infection and recurrence 1
Inadequate post-surgical wound care is a major factor in healing complications and recurrence 5
Patients with significant hirsutism in the sacrococcygeal region are at higher risk for recurrence and may benefit from hair removal strategies 4
Delaying appropriate treatment can lead to more extensive disease requiring more aggressive surgical intervention 2