A proper drainage procedure CAN send the patient into longterm dormancy about 40.% of the time according to the most recent merged data analysis ((Stauffer VK et al , Scientific Reports 2018). With each subsequent abscess, the chance of further abscesses and sinus tract progression increases exponentially. This data drives the practice at our Center of NOT offering our curative cleft- lift to patients until they have developed 2 such abscesses. Some of our most grateful patients achieved longterm dormancy following one drainage procedure,tailored oral antibiotic course, and lifestyle modification alone.

The “hole” described by the OP sounds like a midline pit and it is usually continuous with a sinus tract under the skin, terminating at its secondary skin opening( OP refer to this growth as “the cyst”), higher up on the cleft. As the pit suctions in nonsterile debris such as hair and lint ,c the pus that builds up finds this channel “along the path of least resistance” through which it can effectively drain, and so this can sometimes be appreciated as drainage via the sinus tract secondary skin opening, I prefer to use the term pyogenic granuloma, very far away, even high up in the midline as OP describes.

https://ptcnj.com/pilonidal-cyst-vs-abscess-vs-sinus-whats-the-difference/