A pilonidal cyst is a fluid-filled skin pocket located in the cleft of the buttocks or just above the cleft. These cysts frequently become infected, forming an abscess. Pilonidal cysts typically occur after puberty through age 40, with males disproportionately affected. Obesity, prolonged sitting and the presence of thick body hair increases the risk for pilonidal cysts. Uninfected cysts do not require treatment. Treatment for an infected pilonidal cyst depends on the depth and size of the cyst.
Incision and Drainage
An acutely infected pilonidal cyst provokes pain and drains malodorous pus. This condition typically requires incision and drainage, advises the University of Pittsburgh Medical Center. The procedure involves numbing the skin, then making a small cut into the abscess. The pus is drained and the cyst cavity is packed with strips of sterile gauze to facilitate continued drainage as the wound heals. The gauze may need to be changed a few times by the doctor during the healing process.
Incision and drainage of a pilonidal cyst facilitates resolution of the acute infection. The Mayo Clinic reports that this procedure is effective for approximately 60 percent of people with a pilonidal cyst. The remaining 40 percent of those affected develop repeat infections.
Unroofing
Pilonidal cysts often involve an extensive skin pocket with small openings, or sinus tracts, to the skin surface. Clumps of hair and skin debris fill the skin pocket. Unroofing is a surgical procedure in which the skin over the pilonidal cyst that contains the sinus tracts is removed and the cyst is cleaned, explains the New Zealand Dermatological Society on the patient information website DermNet NZ. The surgical wound may be packed with sterile gauze and left open to heal. Alternatively, the wound may be stitched closed.
Excision
Large pilonidal cysts and those subject to recurrent infections may require surgical excision, or removal of the cyst, notes the American Society of Colon & Rectal Surgeons. Pilonidal cysts often reach deep into the tissues over the tailbone. Thus, excision can be an extensive procedure. Because wound healing in the cleft of the buttocks proves difficult, the surgeon typically must make skin incisions to one or both sides of the pilonidal cyst. Removal of the cyst is performed from the sides of the lesion to permit better healing.
After surgery and wound healing, the affected area must be kept clean, dry and free of hair. The American Society of Colon & Rectal Surgeons recommends people younger than age 30 use a depilatory or shave the area to prevent recurrent disease.
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