Incision and drainage<unk> cking<unk>  >5 cm in diameter
Pilonidal<unk> <unk>  in an immunocompromised or diabetic<unk> tient
Alternative to<unk> cking is loop drainage technique with vessel ties, Penrose Drain, or you can cut the proximal cuff of a sterile glove
Failure rate of 4.1% for loop vessel technique vs 9.8% for conventional<unk> cking. 
Other advantage is don’t have to keep coming back to the ER for<unk> inful repacking.
Home Care (copied from Pediatric EM Morsels)
Keep area clean.
Can cover with gauze to absorb the residual drainage.
Can shower and/or bathe.
The loop drain can be removed when (copied from Pediatric EM Morsels)
Drainage has stopped.
Cellulitis has improved.
Usually is within 7-10 days.
Antibiotics
Although withholding antibiotics is<unk> rt of Choosing wisely ACEP, new evidence suggest antibiotic NNT of 14 to prevent 1 treatment failure
TMP/SMX DS BID x 5 days
Clindamycin is as effective, but with higher adverse events
Consider more aggressive antibiotic treatment if concomitant cellulitis<unk>  >5 cm in diameter
Pilonidal<unk> <unk>  in an immunocompromised or diabetic<unk> tient
Failure rate of 4.1% for loop vessel technique vs 9.8% for conventional<unk> cking. 
Other advantage is don’t have to keep coming back to the ER for<unk> inful repacking.
Home Care (copied from Pediatric EM Morsels)
Keep area clean.
Can cover with gauze to absorb the residual drainage.
Can shower and/or bathe.
The loop drain can be removed when (copied from Pediatric EM Morsels)
Drainage has stopped.
Cellulitis has improved.
Usually is within 7-10 days.
Keep area clean.
Can cover with gauze to absorb the residual drainage.
Can shower and/or bathe.
Drainage has stopped.
Cellulitis has improved.
Usually is within 7-10 days.
Although withholding antibiotics is<unk> rt of Choosing wisely ACEP, new evidence suggest antibiotic NNT of 14 to prevent 1 treatment failure
TMP/SMX DS BID x 5 days
Clindamycin is as effective, but with higher adverse events
Consider more aggressive antibiotic treatment if concomitant cellulitis
Clindamycin is as effective, but with higher adverse events
Abscess
Furuncle
Closed fist infection
Carbuncle
Hernia
Duct ectasia
Weapon of mass destruction
Hidradenitis suppurativa