If a pilonidal cyst becomes acutely infected, it is now called a Pilonidal Abscess. The symptoms of this are severe discomfort; a red, tender lump; and possibly a fever. The natural course of these abscesses can very: it might drain on its own and subside, or it might not drain and require surgical drainage.
Here are some answers to questions about pilonidal abscess
Although it is possible that you won’t have any further problems – many patients do go on to have recurrent problems months or years in the future. Some studies have found that about 50% of patients with an abscess go on to have further problems. According to Murphy’s Law, this usually occurs at the worst possible time, such as when you’ve just started a new job, have no insurance, are on vacation, are preparing to get married, etc. My advice is to consider having a definitive procedure, like a cleft-lift, in the near future at a convenient time. However, it is totally acceptable to take a “wait and see” approach as long as you are aware of the possible outcome. This is discussed further on the page: Pilonidal Disease with Minimal Symptoms.
Once drained (also referred to as “lanced”), a pilonidal abscess heals quickly. In my experience, packing the abscess cavity actually slows down the healing. Unfortunately, there is not universal agreement with my observations. I rarely insert packing or any kind of a drain for an acute abscess (unless it is enormous in size). As long as an adequate incision is made to properly drain the abscess, the infection will quickly resolve, the abscess cavity will close, and the patient will feel better very quickly. Antibiotics may help speed up the recovery – but are probably not absolutely essential. Packing is painful and scary.
These can also be drained in the operating room with sedation or general anesthesia. How it is done depends on what the patient wants. If the abscess is clearly defined and ready to “pop”, it is usually pretty easy and quick to do this in the clinic. But, if the patient has pain – but the outward visible signs are vague – draining this in the operating room with IV sedation is my preference.
This does not provide useful information. We find various different organisms, but the treatment is surgical drainage for an abscess, or a cleft-lift for chronic disease. When an abscess is drained, we usually start antibiotics based on our guess of the bacteria involved. By the time we have culture and sensitivity results, the abscess has usually resolved. Before a cleft-lift procedure, patients are treated with antibiotics that cover gram positive and gram negative and anaerobic bacteria. Studies of the kinds of bacteria involved show a preponderance of anaerobic bacteria, so antibiotics like metronidazole (Flagyl), Clindamycin or Augmentin are often used.