Medical questions & health advice by board certified doctors
"Does a pilonidal cyst flare up always require antibiotics (it's inflamed but painless)?"
I've had a pilonidal cyst for several years that gets flares every few months. Most of the time, the inflammation/pain is minimal and it will go away on its own after a day or two. A handful of times, I've needed to go to the doctor due to unbearable pain and a quick course of antibiotics has always cleared it right up. There have been a few times that it has hurt a little and gotten very swollen and then the pain subsided but the swelling remained for a few days before going away on its own. My question is whether or not it is absolutely vital to take antibiotics when the cyst is inflamed (and there is barely any pain) or if it's okay to let the infection clear on its own. Granted, I know the cyst will never go away unless I get surgery (which I will go get a consultation about with a specialist soon), but basically I'm curious about whether it's okay/safe to see if the flare up goes away on its own, especially since it doesn't hurt, or if it's still important to get antibiotics?
In general, for cysts and abscesses drainage is more important than antibiotics. SO I recommend that you speak with your doctor. Antibiotics will often have a hard time penetrating these sites, whereas drainage allows the bacteria drain out and your body will clear the infection on its own. It sounds like your cysts in general resolve on their own, so antibiotics may not be necessary. Warm compresses and gentle pressure can help them drain and will help them resolve; I would resist the urge to poke at the cyst to cause it to drain. Signs that the infection is more severe and might need antibiotics are severe pain, a lot of redness and swelling around the site, redness and swelling spreading beyond the immediate area of the cyst; if you develop signs of a systemic infection such as fevers, shaking chills, dizziness, light-headedness or nausea I would present to the doctor right away. That being said, it sounds like this is a recurrent problem for you and it would be worth seeing a doctor both to consider a more long-term solution and any time you have symptoms that seem concerning to you. Generally surgeons treat pilonidal cysts, and there are several different possible surgical techniques to prevent the cyst from recurring that they can discuss with you.