Although I feel that surgery is the mainstay of treatment for this problem, you may not feel that is the right choice for you now (or at all!). If you are looking for some home remedies Here are some things to try:
Keep the area as clean as possible by showering or bathing daily with a mild antibacterial soap (Hibiclens is a good choice). Thoroughly dry the area in the cleft afterwards. Some patients recommend soaking in an Epsom salts bath. This may be helpful in washing away debris, killing bacteria, and decreasing swelling around the pores.
Patients who have enlarged pores in the midline of the gluteal crease are the ones who are at risk of developing a painful pilonidal abscess. As long as these pores are open and able to drain, symptoms may be minimal. But, if the area is traumatized by sitting directly on the area, or bouncing in a vehicle, or similar situations – the pore may swell shut, bacteria are trapped under the skin, and an abscess develops. Often patients note that an abscess develops after a situation like this. The trauma to the area doesn’t cause the pilonidal cyst, but may cause it to become infected.
Minimizing the amount of hair available to get caught in the pores can be helpful. Any method that is not irritating to the skin is acceptable, including depilatory agents, shaving, clipping, or laser hair removal. However, this is not a perfect solution, since hairs from anywhere on the body can find their way into the crease, not just the hairs growing locally. In fact, recent studies have shown that most of the hairs in pilonidal cysts come from the back of the head – not the hair on the buttocks and low back. I do not recommend hair removal after a cleft-lift, because it is no longer necessary.
There are many anecdotal reports of patients getting relief by using a topical antiseptic in the gluteal crease. This may be helpful in minimizing the frequency of infections, but there are no good studies on this. Most important is that the antiseptic dry completely after application and not irritate the skin. If it irritates the skin, it may cause swelling of the pores and cause infection rather than prevent it. Common homeopathic antiseptics are tea tree oil, garlic, fenugreek, turmeric, coconut oil, Epsom salts, castor oil, grape seed oil, oregano oil, CBD oil, vinegar, baking soda, Manuka honey, OXY pads, and aloe vera. Again, I must stress that this may minimize frequency of infection, but not cure the problem, and I do not specifically recommend any of these treatments. I would avoid antibiotic ointments, because ointments keep the area chronically moist, which is not healthy for the skin. Also, recommendations are often not clear regarding whether they are recommending use on intact skin vs. open wounds. These remedies are often given a blanket recommendation for all pilonidal disease, but that is not appropriate, and at times not safe. (For example, tea tree oil is to be put on intact skin, while Manuka honey is to help an open wound heal.)
Placing a gauze pad between the buttock cheeks so that air can circulate may be one of the best strategies. This will keep the skin in the cleft dry, allow the pores to drain, and disrupt the pressure phenomenon that draws hairs into the pores. The least expensive, plain, coarse, “gauze” pads at the pharmacy are the best.