Pilonidal ‘Cyst’ – The Dont’s and Dos

Well you can read lots about what to do about pilonidal cysts (by the way it’s not really a cyst, which is the term that thrown around the most, it’s just an infection under the surface of the midline skin of the natal cleft (the skin covering the valley between ones’ buttock cheeks).  

So, while there’s a great deal of advice written on pilonidal cysts/pilonidal disease on the internet and much advice given by doctors in different settings (ERs, urgent cares, hospitals, surgical practices, pediatrician/PCP offices) much of the knowledge and advice is anecdotal, unreliable, and not based on hard or proven facts.  Even many medical book chapters are incorrect.

These writers and medical practitioners are not necessarily at fault. Medical training is very traditional and difficult to change. So many of these practitioners were taught old fashion theories about the etiology (cause) of pilonidal disease. As a result, their recommended treatments are outmoded.

The Sternberg Clinic for Pilonidal Disease is on a mission to educate the medical and patient community to correct the record and help those suffering with Pilonidal Disease to become educated and empowered to seek out the best treatment.

So, about the don’ts:

  • Don’t treat an acute (undrained) pilonidal abscess with antibiotics – get it drained in an ER or by a surgeon (better).
  • Once it’s drained, don’t pack the opening!  Packing acts like a cork and keeps all the infection inside.
  • Don’t rush into surgery.  There is never a need for urgent surgery for pilonidal disease.
  • Don’t stick with a surgeon who tells you that pilonidal disease is caused by a congenital cyst or one who says that a large amount of tissue will need to be removed from your back side.
  • Don’t agree to have an open wound.  Closed wounds with incisions off the midline are the best surgical procedures for pilonidal disease.
  • Don’t agree to an operation where you are required to lie on your stomach for several weeks or months and refrain from sports for months.

And here are the Dos:

  • Once your abscess is drained, Do soak several times a day in a warm tub to draw the infection out.  You may stop, once the area is less swollen, the drainage has begun to subside, and you’re having much less discomfort.  Place a dressing such as gauze over the opening, but don’t pack it (see above).
  • Do your homework!  When confronting surgery, make sure that your surgeon is:
    • Experienced with pilonidal disease and explains this to you in terms that make sense to you.
    • Has performed many (>50 or 100, >1000 even better) Cleft Lift Procedures and is recommending that operation for you.
    • Doesn’t reserve the Cleft Lift Procedure for the worst cases or his recurrences.  The Cleft Lift Procedure in experienced hands, is the best procedure for all pilonidal disease requiring surgery.
    • Comfortable preforming the operation by himself.  If he needs the help of a plastic surgeon, consider looking elsewhere.

Dealing with life-altering pilonidal disease is not easy.  Please do your homework and ask questions before committing to surgery.  If you choose to have surgery, the Cleft Lift Procedure is the operation for you.

Related Reading: Tips for Interviewing a Surgeon


Pilonidal Podcast: Dr. Sternberg explores the disease in 3 min. or less. Ep. 1: What is Pilonidal Disease?

Hosted by Dr. Jeffrey Sternberg, MD, FACS, FASCRS
Founder of The Sternberg Clinic for Pilonidal Surgery in San Francisco, California

Listen to the full audio series

Meet Your Surgeon, Dr. Jeffrey Sternberg

After many years performing major abdominal operations including open and laparoscopic resections for colon cancer, rectal cancer, Crohn’s disease, and Ulcerative colitis, I have chosen to concentrate my efforts in a few highly specialized areas of surgery where I feel I can make the greatest positive impact on patients.

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