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Why does my pilonidal cyst keep coming back?

I am a 23 year old male, with a history of asthma until I was 12. For the last 2 years I have been experiencing my pilonidal cyst slowly grow when I sit on the sofa for over 2 hours. I had the cyst drained and clean it regularly with warm water. However, whenever I sit down on my sofa it keeps getting irritated and I can feel it grow. I have even shaved the hair around the area to prevent the formation of ingrown hairs. I am not sure what to do at this point. Before I had the cyst drained two years ago, I had very bad fevers and felt very weak. There is no weak feeling and I don't have a fever. I am not taking any medications.
Pilonidal cysts are formed when hair is pushed up into the skin, leading to irritation and inflammation. It is not the same as an ingrown hair, because the hair is not originated inside the cyst, and may not even be attached to the skin (barbers can get pilonidal cysts on their hands, for example). Cysts extend as the hair is pushed deeper in the context of trauma or simple contact from sitting, riding in cars, and bicycles. Pilonidal cysts commonly recur after drainage, and can present in several different ways. It sounds like two years ago you had an abscess associated with the cyst, which lead to the signs of infection such as weakness and fevers. Acutely infected cysts are best treated with incision and drainage. However, one half of pilonidal cysts present as a painless lump or draining opening. These cysts still require surgical evaluation to prevent infection and growth. Recurrence can occur despite excellent cleaning and hair removal techniques. You should make an appointment to see your primary care doctor for an evaluation and possible referral to a surgeon who can discuss treatment options with you.
This answer is for general informational purposes only and is not a substitute for professional medical advice.
If you think you may have a medical emergency, call your doctor or (in the United States) 911 immediately. Always seek the advice of your doctor before starting or changing treatment. Medical professionals who provide responses to health-related questions are intended third party beneficiaries with certain rights under ZocDoc’s Terms of Service.

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