Pilonidal Disease: The Daily PANCE Blueprint

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Pilonidal Disease: The Daily PANCE Blueprint

A 31-year-old male with a history of diabetes and obesity presents to the ER due to painful swelling around his buttocks for about 2 weeks. It’s so painful he can barely sit down. His vitals reveal a fever (T 100.7F). On physical exam, a cyst is seen above the gluteal cleft that is tender to palpation. There is erythema around the cyst as well. What is the best next step?

A. Incision and drainage
B. Surgical resection
C. Topical steroid therapy
D. Tract curettage
E. Antibiotics only

Answer and topic summary

The answer is A. Incision and drainage

A pilonidal cyst is a dermatologic disorder defined by inflammation of the superior midline gluteal cleft leading to an abscess and/or fistula. Risk factors include obesity, poor hygiene, sedentary life, excessive body hair, and family history. Clinical features include localized pain in the sacrococcygeal region, purulent discharge, fevers, swelling, and erythema. If the patient is without major symptoms, a conservative approach can be made (improve hygiene). Management for symptomatic patients includes either I&D with secondary wound closure or even surgical resection for refractory cases.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Dermatology ⇒ Other Dermatological Disorders ⇒

Also covered as part of the Family Medicine EOR and Emergency Medicine EOR topic lists

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