Pilonidal Disease

Treatment Overview

No medical treatment is needed for pilonidal disease that is not causing symptoms. If you have been diagnosed with a pilonidal cyst or pilonidal disease, keep the area around the cyst clean and dry. Use an antibacterial soap to wash the area and wipe with an alcohol swab 2 to 3 times a day when the pilonidal area begins to get irritated. Your doctor may instruct you to keep the area cleared of hair by shaving, using a hair-removing lotion (depilatory), or having electrolysis. This reduces the chance of hair entering the cyst and contributing to infection.

If a pilonidal cyst is infected, your doctor will usually prescribe an antibiotic, unless the cyst needs to be drained right away. If antibiotics do not clear up the symptoms, you may need another treatment, such as:

• The cyst is cut open and drained (incision and drainage).
• The cyst is removed (excision).

An incision and drainage is sometimes the first option taken, especially if the cyst is infected. If the pilonidal cyst does not heal, or if it returns, the doctor will perform an excision. Incision and drainage may also be used to reduce the infection before an excision to limit the possibility of the infection spreading. However, the treatment chosen depends on the severity of infection.

Whether you have incision and drainage or excision, it is difficult to heal the wound that is left after the procedure. It is also not uncommon to develop another pilonidal cyst. Be sure to follow your doctor's instructions for caring for the wound and surrounding skin.

Incision and drainage

During incision and drainage, the hair and pus are removed. The sac that forms the cyst is not removed. The wound is packed with gauze and generally heals within 4 to 7 weeks.² This procedure can be done in the doctor's office under local anesthesia. The doctor may prescribe antibiotics to help fight the infection.

Excision

In an excision, the infected material is drained and the entire pilonidal cyst is removed. Because an excision is a complex procedure requiring a deeper cut than an incision and drainage, it is usually done at an outpatient surgical center or hospital under general anesthesia.

After the cyst and infected tissue are removed, the wound may be closed with stitches or sutures (closed method) or left open and packed with surgical gauze (open method). If the wound is packed with gauze, the gauze is changed daily until the wound heals.

Excision of the cyst heals within 10 days to 6 weeks or more, depending on the type of surgery.³ Incision and drainage of the cyst generally heals in 4 to 7 weeks.²

See pictures of an incision and drainage and an excision.

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Author:	Maria G. Essig, MS, ELS	Last Updated: December 14, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Brent Shoji, MD - General Surgery
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