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Pilonidal Cyst, Infected (Incision & Drainage)

A pilonidal cyst is a swelling that starts under the skin on the sacrum near the tail bone. It is present at birth and may look like a small dimple. It can fill with skin oils, hair, and dead skin cells, and may stay small or grow larger. Because it often has an opening to the surface, it may become infected with normal skin bacteria. A pilonidal cyst is different than a hemorrhoid.

Cause

The cause of pilonidal cysts has been debated since they were first recognized. It may be present at birth and go unnoticed. It may appear like a small dimple. Injury, rubbing, or skin irritation may also cause pilonidal cysts. it can also be caused by an ingrown hair. Most likely, the cause is a combination of these things. Because some injury or irritation can lead to pilonidal cysts, it can be more common in people who sit or drive a lot for work.

Symptoms

A pilonidal cyst may be small and painless. If symptoms occur, they may include:

  • Swelling

  • Irritation or redness

  • Pain

  • Drainage

The cyst can swell and drain on its own. The swelling and drainage can come and go.

Treatment

If the infection is limited, it may be treated with antibiotics alone. If the infection is more severe or gets worse, it needs to be drained. Often, this can be done with a small incision using local anesthesia. In some cases, surgery is needed to treat it or prevent it from returning.  

After the incision and drainage, gauze packing may be inserted into the opening. If so, it should be removed in 1 to 2 days. Antibiotics are not required in the treatment of a simple abscess, unless the infection is spreading into the skin around the wound. The wound will take about 1 to 2 weeks to heal depending on the size of the cyst.

Home care

Wound care

  • Pus may drain from the wound for the first few days. Cover the wound with a clean dry bandage. Change the bandage if it becomes soaked with blood or pus, or if it gets soiled with feces or urine.

  • Sit in a tub filled with about 6 inches of hot water. Keep the water hot  for 10 to15 minutes.

  • If gauze packing was placed inside the cyst cavity, you may be advised to remove it yourself. You may do this in the shower. Once the packing is removed, you should wash the area carefully in the shower once a day, until the skin opening has closed. It is okay to direct the shower spray directly into the opening if this is not too painful.

Medications

  • Take acetaminophen or ibuprofen for pain, unless you were given a different pain medicine to use. If you have chronic liver or kidney disease or have every had a stomach ulcer or gastrointestinal bleeding, or are taking blood thinner medications, talk with your doctor before using these medications.

  • If you were given antibiotics, take them until they are gone. To make sure the infection has cleared, it is important to finish the antibiotics even if the wound looks better.

  • Use antibiotic cream or ointment.

Prevention

Once this infection has healed, the following may decrease the risk of future infections:

  • Keep the area of the cyst clean by bathing or showering daily.

  • Avoid tight-fitting clothing to minimize perspiration and irritation of the skin.

  • Recurrent pilonidal cysts may be completely removed by surgery. But this can only be done at a time when there is no infection. Ask your doctor for more information.

Follow-up care

Follow up with your doctor as advised by our staff. If a gauze packing was inserted in your wound, it should be removed in 1 to 2 days. Check your wound every day for the signs listed below.

When to seek medical care

Get prompt medical attention if any of the following occur:

  • Pus continues to come from the cyst for 5 days after the incision

  • Increasing redness, local pain, or swelling

  • Fever over 100.4°F (38.0°C) for more than 2 days

 

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