Treatment of Pilonidal Cysts

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, 2
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, 3
After surgical drainage, the wound can be managed in one of two ways: open wound healing (secondary intention) by simply covering the surgical site with a dry dressing 2, or closed wound healing (primary closure) by suturing the wound closed 2

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, 2
For recurrent pilonidal abscesses, a 5-10 day course of antibiotics active against the cultured pathogen may be considered 1