Treatment Pilonidal Sinus

Conservative treatment Pilonidal Sinus

Healing without surgery? Can you treat one Pilonidal Sinus yourself?

Thecause of Pilonidal Sinus is hair that has penetrated under the skin. A lasting healing of the fistula only occurs if the hairs in the fistula tract are removed. 

The hairs are often firmly attached to the fistula capsule. Only in the early stages can they be completely pulled out or "brushed out".

Each Pilonidal Sinus has an entrance gate. In the case of a fistula that has not been pre-operated on, this is the Pit or PorusAt the recurring Pilonidal Sinus often a funnel-shaped retraction at the lower scar pole.

This entry portal is lined with skin (epithelized) if the fistula has existed for a long time. Consequently, it cannot heal on its own.

Conservative therapy for Pilonidal Sinus

With conservative measures you can

  • gain time if an operation is not immediately possible or desired
  • create optimal conditions for the intervention in preparation for surgery 
  • achieve stable healing in the post-operative treatment after an operation.
Our referral light:

Sections highlighted in green describe a treatment that we recommend

We consider yellow-shaded therapy options to be suitable under certain circumstances

Red indicates that we consider the treatment unsuitable or that it is not offered in Germany

hair removal

Is hair removal in the area of the gluteal fold useful?

Where does the hair that you Pilonidal Sinusfind in a cave come from? 

  • The hair mainly comes from hair roots in the area of the gluteal fold
  • New studies show that hair from the head can also be found in the fistula ducts, hair from the back only rarely. Short, freshly cut hair from the neck seems to penetrate the skin most easily.
  • Furthermore, it happens that deposits of keratin dandruff due to a disturbed hair formation lead to an expansion of the hair root. 

In my experience, a hair-free gluteal fold reduces the risk of healing disorders after surgery. Many supposed relapses are in fact poorly healed operation scars (type IV fistulas), which could probably have been avoided by consistent hair removal in the early phase after an operation.

However, procedures that only remove the visible hair parts (shaving, epilation, waxing, sugering) cannot influence the hair root in depth and thus the risk of a real relapse.

The penetration of loose hair from other parts of the body is best achieved by covering with a closed bandage.

shaving

Useful, no matter or harmful?

Everything for an optimal Pilonidal Sinus post-operative treatment
Alcohol-free antiseptic, hospital razor and bikinizon razor

We observe in the course of post-operative care that 90% of all problems are caused by mechanical irritation of the wound by the surrounding hair.

We therefore recommend shaving until the wound is closed and the scar is stable. In the early phase of wound healing, the scar tissue is still soft and vulnerable, so that hairs can reattach. 

The easiest way to shave is with the simple disposable razors ("hospital razors", e.g. from Wilkinson®) after spraying with an alcohol-free antiseptic (e.g. Octenisept®). The viscous consistency of this product ensures that the razor glides effortlessly over the skin and the shaved stubble does not fall into the wound. The antiseptic effect prevents skin irritations. A bikini line razor may be helpful in areas that are difficult to reach. The use of clippers or beard trimmers should also work.

Tips for a successful shave can be found in our video:

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Epilating, waxing, sugering

Better than shaving?

In conventional epilation, the hairs are torn out with a rotating tweezer system (e.g. Braun Silk-épil, Philips SatinPerfect), wax strips or a sugar paste.

Pulling on the hair causes the hair to break off just above the hair root, the root and growth zone are not removed. Externally, there will be hair free for a few weeks, but the hair will always grow back.

This epilation technique is mainly suitable for cosmetic hair removal. It seems unlikely that it can prevent the formation of onePilonidal Sinus . In contrast, for post-operative treatment after radical surgery, depilation may be a means of preventing the hair from growing from the side into the still open surgical wound.

Epilation
Mechanical depilation © istockphoto.com

Laser Hair Removal

Even the best surgical technique cannot guarantee a 100% success rate. If a fistula occurs again after an operation, either new "pits" have formed or hairs have drilled into the less stable scar tissue. This problem can be prevented if the hair roots in the critical area are permanently inactivated by light energy. A recent study showed a halving of the recurrence rate after surgery from 19.7% to 9.3% after laser hair removal.

ointments

Has an herb grown against the Pilonidal Sinus?

Abscess Ointments, "Train Ointments"

These preparations are registered as traditional medicinal products without registration studies solely on the basis of many years of use for the area of application. They are intended to promote the "maturation" and spontaneous opening of encapsulated centres of pus (abscesses). Since most abscesses burst at some point if you wait long enough, the benefit of these preparations does not seem to be proven.

  • ilon® Ointment classic (successor product to ilon® Abscess Ointment): Ingredients are larch turpentine (Terebinthina veneta), turpentine oil of the beach pine type eucalyptus oil, white vaseline, yellow wax, stearic acid, oleic acid, polysorbate 20, rosemary oil, thyme oil, thymol, chlorophyll-copper complex (E141), butylhydroxytoluene (E321). My literature - research on "turpentine" and "abscess" only revealed the reference to the use since 2000 years, the causation of abscesses by turpentine injection in experimental animals and studies on contact allergies caused by turpentine. 
  • Ichtholan 50% ® Ointment contains the active ingredient ammonium bituminosulfonate (ichthyol), yellow vaseline, microcrystalline hydrocarbons (C40-C60), wool wax and purified water. Ichthyol belongs to the group of sulfonated shale oils and has been used since the 19th century as an anti-inflammatory and antibacterial agent in dermatology, in higher concentrations of 20 - 50 % also for abscesses. The medical database PubMed does not find a single study on the treatment of abscesses for this active substance either.

antibiotics

Antibiotics are not treatment of first choice. They can help to contain an acute inflammation and thus save time. In the case of acute symptoms, e.g. on holiday, such treatment can sometimes bridge the time until the patient is able to return home. However, the success of antibiotic treatment is a matter of luck:

There is always a mixed spectrum of different bacteria, so that broad-spectrum antibiotics are necessary (e.g. cefuroxime, amoxicillin/clavulanic acid). However, it is quite possible that the bacteria causing the inflammation are resistant to the antibiotic used or that the antibiotic does not reach a sufficient level of effectiveness at the site of inflammation. A healing of the fistula can never be achieved with antibiotics. 

Antibiotics for Pilonidal Sinus
Antibiotics for Pilonidal Sinus

Phenol - Instillation

(not available in Germany)

The method was first described by Lawrence and Greenwood in 1964. They state a cure in 84% of cases. 

Girgin reports a success rate of 64.5% for single and 95% for repeated introduction of crystalline phenol into the fistula tract. The treatment is carried out under local anaesthesia, the hair is removed from the fistula tract with a clamp and the tract is rinsed. The surrounding area is kept hair-free during the entire healing period.

According to German drug law, phenol may no longer be used (negative monograph Pharm. Ztg. 143 (1997), 4103 and 4386). It is toxic and irritates skin and mucous membranes.

The accompanying measures correspond to a restrained pit picking. An additional benefit of the phenol therefore does not seem to me to be proven.

phenol2.svg
Chemical formula of phenol © By NEUROtiker
Studies on phenol instillation
Author
Year
Quantity
% Follow up
Years Follow up
% Recurrence
% Complication
Maurice
1964
21
Not specified
1,5
19
Not specified
Aygen
2010
36
100
4,5
13,9
8,3
Girl
2012
48
96
1,83
5,0
Not specified
Calikoglu
2017
70
95,9
3,3
14,3
8,6
Dogru
2020
1026
Not specified
Not specified
15,7
Not specified

Vaseline, Henna and Tetracycline - the mixture from Iraq

(not available in Germany)

A randomized study on 400 patients was published by the University of Sulaymani in Kurdistan. In the therapy group a mixture of 100 g vaseline, 50 g henna powder (Lawsonia inermis) and 5 g tetracycline was injected into the fistula tract. In the control group the fistula was excised with primary wound closure. Healing rates were 94 % for surgery and 89 % for ointment injection. Unfortunately, I did not find any information in the work on the follow-up rate and the observation period. Conclusion: Unconventional idea, assessment not possible.

Ayurvedic medicine

(not available in Germany)

Traditionally in Ayurvedic medicine, thread drains impregnated with plant extracts and salts are used for fistula treatment. A publication can be found on a Combination of surgical excision, sclerotherapy with hot oil and application of copper sulphate. The scientific findings on these methods allow only anecdotal mention, but no evaluation of the procedure.

food supplement

With an otherwise balanced diet, we are of the opinion that a specific dietary supplement is not necessary.

Live smoke-free

We don't need to tell you that smoking is not healthy. That smoking at Pilonidal Sinus least doubles the recurrence rate after an operation might interest you after all. And for acne inversa, smoking is the major risk factor. If you want, we have some good ones. Tips on how to quit smoking easier than you think you can!

Follow-up treatment after surgery of a pilonidal sinus

- just as important as the intervention itself!

There is no doubt that most problems and also so-called recurrences arise after an operation due Pilonidal Sinusto an unsuccessful or neglected follow-up treatment. In the following we want to explain which measures are indispensable from our point of view and which are of questionable value.

Ardelt, M., & Settmacher, U. (2016). Limberg Flap Is Rhombic, Not Rhomboid. Plastic and Reconstructive Surgery, 137(2), 494e-495e

Azab AS, Kamal MS, Saad RA, Abou al Atta KA, Ali NA. Radical cure of pilonidal sinus by a transposition rhomboid flap. Br J Surg. 1984;71(2):154-155

Azab, A., Kamal, M., & el Bassyoni, F. (1987). The rationale of using the rhomboid fasciocutaneous transposition flap for the radical cure of pilonidal sinus. The journal of dermatologic surgery and oncology, 12(12), 1295-9.

Banerjee, D. (1999). The aetiology and management of pilonidal sinus. Journal of Wound Care, 8(6), 309-310.

Bascom, J. (1983). Pilonidal disease: Long-term results of follicle removal. Diseases of the Colon & Rectum, 26(12), 800-807

Delshad, H., Dawson, M., Melvin, P., Zotto, S., & Mooney, D. (2019) Pit-picking resolves pilonidal disease in adolescents. Journal of Pediatric Surgery, 54(1), 174-176.

Iesalnieks, I., Deimel, S., & Schlitt, H. (2014). "Pit-picking" surgery in patients with pilonidal sinus. The surgeon, 86(5), 482-485.

Karydakis, G. (1974). New approach to the problem of pilonidal sinus. Lancet (London, England), 2(7843), 1414-5.0

Karydakis, G. E. (1992). Easy and successful treatment of pilonidal sinus after explanation of its causative process. Anz Journal of Surgery, 62(5), 385-389.

Limberg AA. Modern trends in plastic surgery. Design of local flaps. Mod Trends Plast Surg. 1966;2:38-61

Lord, P., & Millar, D. (1965). Pilonidal sinus: A simple treatment. British Journal of Surgery, 52(4), 298-300.

Melhorn, S., & Staubach, P. (2019). Ammonium bituminosulfonate. The dermatologist, OnlineFirst, 1-3

Pronk, A., Eppink, L., Smakman, N., & Furnee, E. (2017). The effect of hair removal after surgery for sacrococcygeal pilonidal sinus disease: a systematic review of the literature. Techniques in Coloproctology, 22(1), 7-14.

Salih, A., Kakamad, F., Salih, R., Mohammed, S., Habibullah, I., Hammood, Z., Aziz, M., & Baba, H. (2018). Nonoperative management of pilonidal sinus disease: one more step toward the ideal management therapy-a randomized controlled trial. Surgery, 164(1), 66-70.

Tripathy, R., John, N., Vijayalekshmi, S., Nair, N., & Pasupalan, S. (2019). Taila Dāha (Cauterization with Oil) to Innovative Approach in Pilonidal Sinus. Ancient science of life, 36(2), 104-109.

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