Have no fear. With the correct treatment, it gets better quickly!
Symptoms that require immediate action include pain, redness, swelling, drainage, and fever.
Call your nearest general surgeon or, more preferably, a pilonidal specialist. It is advantageous if you see a pilonidal specialist first because you can establish a relationship with a pilonidal specialist, and they can plan the appropriate course of treatments that will give you the best possible outcomes with the least amount of setbacks. For example, most practitioners (not knowingly) will make the incision for the abscess in the middle of the pilonidal wound. This creates a potential problem because the wound can take longer to heal or may never heal if performed in this way. The best way is to drain it off the “midline,” so the pilonidal wound has the quickest and best chance of healing.
If neither is available immediately, contact your primary care doctor or go to your nearest urgent care center or emergency room.
Our office is always available to help you in an acute situation and can either treat you directly if you are in the area or at least guide you in the interim until more definitive care can be given in the future.
If possible, the initial treatment for an acute pilonidal abscess is oral antibiotics for two weeks and a culture. If there is a drainable abscess, it will be performed in the office under local anesthesia.
If the abscess is too large and painful, we would have to send the patient to the local emergency department for drainage of the pilonidal abscess under general anesthesia.
After drainage, the pilonidal wound is packed with a special gauze, and specific wound care instructions will be given to you.
The wound usually heals within two weeks. Most patients can shower the next day and resume normal daily functions with little limitations after a day or two.
We do not recommend this approach to treat an acute pilonidal abscess. However, if absolutely needed because of time, money, or having no access to immediate medical care and symptoms are MILD, it can sometimes be treated from home. But ALWAYS speak to someone or follow up with a medical professional as soon as possible.
Do not try to open it with a sharp instrument, and do not squeeze with your finger.
One effective strategy is to apply warm, moist compresses to the area for about 15 minutes four times daily.
You can also add soaking in warm water with or without Epsom salt.
Oral antibiotics are an adjunct to treatment and are necessary. However, the majority of the treatment for the abscess alone is for it to drain, either spontaneously or surgically.
Topical antibiotics do not penetrate the skin and have little role in treating an acute pilonidal abscess. It can help cool down surrounding skin inflammation and can use things like tea tree oil, bacitracin, witch hazel, Hibiclens, or Neosporin ointment.
If the pilonidal abscess does not drain within 24 hours and your symptoms do not improve, you must seek immediate medical attention. Infections can spread rapidly and, if not controlled, can lead to a localized spread of infection. Ultimately, bacteria can enter the bloodstream and cause a drop in blood pressure and a severe life-threatening condition known as sepsis.
If the pilonidal wound is thoroughly healed and stable, it may never return, and definitive surgical management may not be needed. Nevertheless, the wound should be seen, and your case should be discussed with your pilonidal surgeon.
Unfortunately, pilonidal abscess drainage is only to fix the immediate, acute problem and does not prevent future occurrences. Often they come back and or never heal completely and become a chronic condition. This is why developing a relationship with your pilonidal surgeon is important to discuss your course of action. Options include a “wait and see” approach if the pilonidal abscess is completely healed and it's the first time or possible definitive surgical management.
Don't let that get you down because, ultimately, you will be cured! One way or another!
If conservative management has failed and the pilonidal disease is recurrent or chronic, surgical treatment is best. The procedure with the highest cure rate is the Cleft Lift Procedure, and has a less than 5% fail rate. It has become the gold standard in the treatment of pilonidal disease. I am one of the very few surgeons across the country that can perform the procedure, and I have dedicated most of my practice to it.
Most patients tell me that the treatment of a pilonidal abscess is much more painful and inconvenient than getting the Cleft Lift procedure. The recovery is immediate, with most not needing any pain medications after surgery and are fully functional.
For the most advanced treatment, easiest recovery, and best possible results with minimally invasive surgery in New Jersey, begin your journey with Dr. Shomaf Nakhjo today. Schedule your consultation at either of our convenient locations to begin discussing your personalized treatment plan with a highly skilled and renowned area specialist.