Pilonidal Cyst (cont.)

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How is a pilonidal cyst diagnosed?

A pilonidal cyst can be diagnosed by your health-care professional based on your symptoms and the findings on your physical exam. No blood work or imaging studies are usually necessary to make the initial diagnosis.

What is the treatment for a pilonidal cyst?

For those individuals who have a dimple or sinus tract without symptoms and that has not become infected, no immediate treatment is necessary. However, if there are any signs or symptoms of an infected pilonidal cyst (pilonidal abscess), then incision and drainage is necessary. Generally speaking, this procedure can usually be performed in a physician's office or in an emergency department with local anesthesia.

  • Using sterile technique and after placing the patient in the prone (facedown) position, the infected area is numbed with an injection of local anesthetic.
  • Using a scalpel, a longitudinal incision is made into the skin off the midline to drain the pus, and remove hair and any other debris from the wound.
  • The wound is packed with ribbon wound packing in order to allow continued drainage and then dressed and allowed it to heal.

Antibiotics are not necessary unless your physician feels that you have a spreading skin infection (cellulitis). Pain medication will often be prescribed. You will then need to follow up with your health-care professional in a timely manner to ensure proper wound healing and to monitor for any potential complications. The ribbon wound packing may be removed by your health-care professional if there is no continued purulent drainage. Otherwise, treatment at home will consist of pain control, wound care, and cleansing of the wound using warm shower water or Sitz baths once the packing has been removed. The skin wound will eventually close and heal on its own, and keeping the area clean and free of any hair will help prevent the recurrence of pilonidal disease. If you encounter any signs or symptoms of continued infection, or if the wound fails to heal, prompt follow-up should be arranged with your health-care professional. In the majority of cases, the wound heals completely in approximately one month.

For those individuals with recurrent, complicated, or chronic pilonidal disease, more invasive surgery may be necessary in an operating room. Several different surgical techniques may be used, and your surgeon will discuss the various options with you. In general, the major difference in surgical techniques involves either leaving the surgical wound open after surgery and allowing it to heal (requiring a longer healing time but having a lower recurrence rate) versus closing the surgical wound after debridement during the surgery itself (with a shorter healing time but higher recurrence rate). Another surgical technique involves suturing the skin edges of the wound and allowing the open wound to slowly heal (marsupialization). Healing time and recovery vary based on the surgical technique used and may range from several weeks to several months. Finally, the treatment of pilonidal disease using a series of phenol injections is another alternative to surgery alone, although this option is more commonly used in Europe than in the United States. Follow-up with your surgeon should be arranged after your procedure, and meticulous wound care and hygiene are necessary to ensure proper wound healing and to prevent recurrence.

Medically Reviewed by a Doctor on 4/30/2014

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