Boils Slideshow Pictures

Medical Author:

Steven Doerr, MD

Steven Doerr, MD

Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Pilonidal Cyst Treatment

Individuals who simply have a dimple or sinus tract that has not become infected or inflamed do not generally require any immediate treatment. However, an infected pilonidal cyst is an abscess that requires incision and drainage (lancing) in order to improve. This procedure can generally be performed in a physician's office or in the emergency department. After numbing the area with an injection of a local anesthetic, an incision with a scalpel is made over the infected area off the midline. The physician will then drain the pus and remove hair and any other debris from the wound. The wound is then packed with gauze and allowed to heal. Antibiotics are generally not necessary unless your physician feels that you have a spreading skin infection (cellulitis). Pain medication will often be prescribed.

Follow-up with your physician should be arranged to ensure adequate wound healing and to monitor for any potential complications. The wound packing will be removed by your physician, and repacking of the wound may be required if there is still purulent drainage. Treatment at home will consist of medications for pain control and proper wound care. Sitz baths can be taken at home once the packing has been removed, and the skin wound will generally heal and close on its own. Keeping the wound area clean and removing any hair from around the sacrococcygeal area can help to prevent recurrence.

For those individuals with recurrent or complicated pilonidal cysts, more invasive surgery may be necessary in an operating room. Several different surgical procedures may be used in this case, and your surgeon will discuss the various options with you. In general, the major difference between the various surgical interventions centers around leaving the surgical wound open after surgery and allowing it to heal versus closing the surgical wound after debridement during the surgery itself. Recovery time after surgery can take several weeks.

The treatment of pilonidal disease using phenol injections is another alternative to surgery alone, although this option is more commonly employed in Europe than in the United States. Continued outpatient care with a general surgeon is necessary to ensure proper wound healing, and to manage any potential complications or recurrence of pilonidal disease.