Can a cream treat a pilonidal cyst or sinus?

Name: Can a cream treat a pilonidal cyst or sinus?
Published: 2026-10-05

In patients with pilonidal cyst or sinus disease, does the application of a topical cream (antiseptic, antibiotic, or hair-removal/depilatory cream) improve healing, reduce symptoms or recurrence, or reduce the need for surgery compared with standard care or no cream?

Compiled 2026-10-05 · checked 2026-10-05 · next 2026-11-05 · automated review, how it works

Bottom line

Creams do not treat a pilonidal cyst or sinus on their own — most evidence shows no meaningful benefit, and surgery remains the main effective treatment.

Almost all the studies here tested a cream as a wound dressing after surgery, not as a way to treat or avoid surgery for an intact cyst. The two best-designed trials, both using zinc oxide cream on wounds after surgery, found no real difference in healing compared with a placebo cream.

How certain

Moderate

One well-conducted randomised trial addresses this question directly.

What it shows

No meaningful benefit

Most of the evidence found no meaningful difference.

studies found: 26studies found
randomised trials: 5randomised trials
people studied: 3,001people studied
reviews of trials: 5reviews of trials
years covered: 1987–2025years covered

What the research shows

Healing of an intact cyst or sinus without surgery
No trial tested a cream as a stand-alone treatment meant to heal a cyst or sinus instead of surgery. Small studies that reported improvement with cream had no comparison group, so it's unclear if the cream caused it.[1,2]
Not studied
Wound healing speed after surgery
Results differ by which cream was tested. Two placebo-controlled trials of zinc oxide cream found no real difference in healing speed. One trial of a different cream (Lietofix) found a possible benefit, and small trials of henna, collagenase, or bark extract also reported faster healing — but each came from a single small study.[1,2,3,4,5,6]
Insufficient evidence
Avoiding the need for surgery by using cream
No study tested whether applying a cream to a cyst or sinus could prevent the need for a surgical procedure. Every cream study here was done either after surgery or alongside another treatment like a chemical injection.
Not studied
Symptom relief (pain, discharge, swelling)
Very few studies measured symptoms directly. One small uncontrolled case series reported that most patients improved on a polyphenol cream, but without a comparison group this can't be credited to the cream.[1]
Insufficient evidence
Skin reactions to the cream
Adverse skin reactions weren't tracked consistently across studies. In one small case series, a patient stopped a honey-based treatment because of a reaction, but this wasn't studied systematically.[1]
Insufficient evidence

What it may help with

After surgery, one specific cream (Lietofix) may modestly increase the chance a wound heals within 30 days compared with an iodine dressing — but this is about wound care after surgery, not treating a cyst in place of surgery, and comes from a single trial.[1]
A depilatory (hair-removing) cream used alongside phenol treatment was linked to lower recurrence than not removing hair in one retrospective study — but the cream's job there was hair removal, not treating the cyst itself.[1]

Important limitations

Most studies here treat the open wound left after surgery, not an intact cyst or sinus. None of them answer whether cream could replace or avoid surgery, which is the question most people searching this actually want answered.[1,2,3,4,5,6,7]
Many studies have no comparison group — they just followed one group of patients using a cream and reported what happened, so there's no way to know if the cream caused the result or people would have improved anyway.[1,2,3,4,5,6]
Sample sizes are often very small, sometimes under 20 people, so chance alone could easily explain the differences reported.[1,2,3,4]
Most studies are low or very low quality, with retrospective designs and no blinding, which makes it hard to trust the reported benefits.[1,2,3,4,5,6,7]

What the studies found

Found a benefit14 · 54%
Found no clear effect2 · 8%
Mixed or unclear10 · 38%

What kind of studies

Retrospective7 · 27%
Case series6 · 23%
Randomised trial5 · 19%
Systematic review4 · 15%
Guideline1 · 4%
Meta-analysis1 · 4%
Narrative review1 · 4%
Prospective cohort1 · 4%

The studies that decided it

Herrod et al. 2022
Dressings and topical agents for the management of open wounds after surgical treatment for sacrococcygeal pilonidal sinus
Cream may speed wound healing.Meta-analysisLow quality
205 people30 days
Lietofix cream may increase the proportion of wounds that heal by 30 days compared with an iodine dressing, based on one low-certainty trial
Who was studied
young adults (mostly male) who had surgery for a pilonidal sinus and were left with an open wound to heal
What they received
Lietofix cream
Compared with
an iodine dressing
Main outcome
proportion of wounds healed by 30 days
Quality
The finding comes from a single trial with high risk of bias, so confidence in the result is low.
Limitations
All studies were at high risk of bias in at least one domain, and this comparison relied on a single trial of 205 participants.
Taken word for word from the abstract
- n 205 participants, 1 study; low-certainty evidence
- intervention Lietofix cream
- comparator an iodine dressing
- primaryOutcome the proportion of wounds that heal by 30 days
- result Lietofix cream may increase the proportion of wounds that heal by 30 days compared with an iodine dressing (comparison 4; RR 8.06, 95% CI 1.05 to 61.68; 205 participants, 1 study; low-certainty evidence).
- population Mean participant ages were between 20 and 30 years, and nearly 80% of participants were male.
- population participants who had undergone any type of sacrococcygeal pilonidal sinus disease surgery and were left with an open wound
Cochrane Database Syst Rev · PMID 35593897 · Read it on PubMed ↗
Kargın et al. 2021
Is Hair Removal Necessary after Crystallized Phenol Treatment in Pilonidal Disease?
Hair removal cream aided phenol treatment, not alone.RetrospectiveLow qualityRelated question
735 people46.23 ± 33 (range, 11-240) months
hair removal was associated with significantly less recurrence (OR 0.54) and longer hair removal duration further reduced recurrence odds
Who was studied
patients with pilonidal sinus disease treated with crystallized phenol
What they received
hair removal using depilatory cream combined with crystallized phenol treatit
Compared with
patients who did not undergo hair removal or had shorter hair removal duration
Main outcome
recurrence of pilonidal sinus disease after treatment
Quality
This is a retrospective study relying on phone/email follow-up without randomization, so the effect of hair removal cream (as an adjunct, not the main cyst treatment) is less certain.
Limitations
Retrospective design, reliance on patient-reported recurrence via phone/email, and the cream was used only for hair removal alongside the actual phenol treatment, not as a stand-alone cyst therapy.
Taken word for word from the abstract
- n Of 1,016 patients, 735 were contacted by telephone or e-mail regarding the frequency of sacrococcygeal hair removal and recurrence.
- population Patients with PSD who were treated with crystallized phenol treatment were evaluated.
- intervention Hair in the sacrococcygeal area was removed with depilatory cream before every crystallized phenol procedure, during the treatment, and after treatment once a month for 6 years.
- comparator Patients who underwent hair removal experienced significantly less recurrence than those who did not
- primaryOutcome Demographic and sinus features and crystallized phenol application data of patients treated with crystallized phenol for PSD, as well as recurrences were retrospectively assessed.
- result Patients who underwent hair removal experienced significantly less recurrence than those who did not (p = 0.003, odds ratio [OR]: 0.54 [95% CI: 0.36-0.82]).
- followUp The mean follow-up time was 46.23 ± 33 (range, 11-240) months
Med Princ Pract · PMID 33915547 · Read it on PubMed ↗
Aksoy et al. 2019
Topical polyphenol treatment of sacrococcygeal pilonidal sinus disease: use of ultrasonography to evaluate response to treatment - clinical case series study
Most patients healed without surgery.Case seriesVery low quality
14 people18.3 months
most patients improved or were disease-free after treatment
Who was studied
young adults aged 18-45 with sacrococcygeal pilonidal sinus disease
What they received
topical natural polyphenol cream applied for a median of 3 months
Compared with
none (before-and-after comparison, no control group)
Main outcome
disease resolution assessed by physical exam and ultrasonography
Quality
This was a small, uncontrolled case series without a comparison group, so it can't rule out natural improvement or bias.
Limitations
Retrospective, no control group, small sample size of 14 patients
Taken word for word from the abstract
- n Fourteen patients with SPSD diagnosis were treated by natural polyphenol products and were retrospectively included in this study.
- population Patients were aged 18-45 years and the median disease duration was 2 years.
- intervention All of the patients applied topical polyphenols for a median period of 3 months.
- comparator Fourteen patients with SPSD diagnosis were treated by natural polyphenol products and were retrospectively included in this study.
- primaryOutcome To assess effectiveness of topical polyphenol treatment of SPSD by using physical examination and ultrasonography (USG).
- result Topical polyphenol treatment was effective in 92.9% of patients. Follow-up examinations at 18.3 months post-treatment revealed that 12 (85.7%) patients were free of disease.
Postepy Dermatol Alergol · PMID 31616217 · Read it on PubMed ↗
Pronk et al. 2018
The effect of hair removal after surgery for sacrococcygeal pilonidal sinus disease: a systematic review of the literature
Cream removal didn't lower recurrence.Systematic reviewLow qualityRelated question
963 people37.0 (standard error of the mean: 35.0) months
recurrence was higher with razor/cream hair removal (23.4%) than with no hair removal (19.7%), while laser hair removal had the lowest recurrence (9.3%)
Who was studied
adults who had surgery for pilonidal sinus disease near the tailbone
What they received
hair removal with razor shaving or cream depilation after surgery
Compared with
no hair removal after surgery
Main outcome
rate of cyst/sinus recurrence after surgery
Quality
the included studies were mostly small retrospective cohorts with limited methodological quality, so the comparison is not very reliable.
Limitations
small sample size and limited methodological quality of the included studies
Taken word for word from the abstract
- n involving 963 patients
- population patients surgically treated for SPSD
- intervention razor shaving/cream depilation
- comparator no hair removal after surgery for SPSD
- primaryOutcome the effect of hair depilation on the recurrence rate in patients surgically treated for SPSD
- result 23.4% (36 out of 154 patients) in those who had razor shaving/cream depilation, and 19.7% (85 out of 431 patients) in those who had no hair removal after surgery for SPSD
Tech Coloproctol · PMID 29185064 · Read it on PubMed ↗
Mirastschijski et al. 2013
Zinc, copper, and selenium tissue levels and their relation to subcutaneous abscess, minor surgery, and wound healing in humans
Zinc cream no better than placeboRandomised trialLow quality
42 people2013
topical zinc cream was only mediocre for healing compared with placebo, though it doubled zinc levels in the wound tissue without changing copper or selenium levels
Who was studied
adults with pilonidal sinus disease having surgery
What they received
topical zinc oxide cream applied to the wound
Compared with
placebo cream
Main outcome
wound healing and zinc, copper and selenium levels in the wound tissue
Quality
small study of 42 patients looking mainly at tissue chemical levels rather than a clear clinical healing outcome
Limitations
small sample size and the healing outcome is described only briefly, with the main data focused on trace element concentrations rather than clinical wound closure
Taken word for word from the abstract
- n 42 (33 males) pilonidal disease patients
- population pilonidal disease patients
- intervention topically with placebo or zinc
- comparator treated topically with placebo or zinc
- primaryOutcome regional concentrations within granulating wounds treated topically with placebo or zinc
- result The effect of topical zinc on the closure of the excisional wounds was mediocre compared with placebo.
- result Topical zinc oxide treatment doubled (p < 0.050) zinc concentrations in the three tissue localizations without concomitant significant changes of copper or selenium levels.
Biol Trace Elem Res · PMID 23595590 · Read it on PubMed ↗
Agren et al. 2006
A randomized, double-blind, placebo-controlled multicenter trial evaluating topical zinc oxide for acute open wounds following pilonidal disease excision
No difference in healing time.Randomised trialModerate quality
64 people2006
no significant difference in healing time, though zinc reduced bacterial infection and antibiotic use
Who was studied
adults after surgical removal of pilonidal cyst/sinus, with open wounds left to heal
What they received
topical zinc oxide cream applied to the open wound
Compared with
placebo mesh dressing
Main outcome
time to complete wound healing
Quality
it was a well-designed randomized, blinded trial but fairly small, so it may miss true differences in healing time.
Limitations
authors state larger trials are needed to show definitive effects on healing and infection
Taken word for word from the abstract
- n Sixty-four (53 men) consecutive patients
- population secondary healing pilonidal wounds
- intervention topical zinc oxide with placebo mesh
- comparator placebo mesh
- primaryOutcome masked assessment of time to complete wound closure
- result Median healing times were 54 days (interquartile range 42-71 days) for the zinc and 62 days (55-82 days) for the placebo group (p = 0.32).
Wound Repair Regen · PMID 17014663 · Read it on PubMed ↗

All 26 studiesEvery study that answered the question, with its design, size and result.

The other 20 studiesEverything else the search returned, including anything retracted.

Khosravi et al. 2025
Wound-Healing Properties of Henna in Pilonidal Sinus Surgery: A Randomized Study
Faster wound healing after surgery.Randomised trialLow qualityRelated question
60 people28
henna ointment reduced wound length, depth and volume more than phenytoin or eucerin after two weeks
Who was studied
patients with open wounds after surgery for pilonidal sinus
What they received
henna (Lawsonia inermis extract) ointment applied to the wound
Compared with
phenytoin ointment or eucerin ointment (inactive control)
Main outcome
wound length, depth and volume measured after surgery
Quality
small trial of 60 patients split into three groups, short follow-up, and it treats healing of an existing surgical wound rather than the cyst itself.
Limitations
small sample size per group and short follow-up period; studies wound healing after surgical excision, not treatment of an intact cyst or sinus without surgery
Taken word for word from the abstract
- n involved 60 patients with open post-operative PS wounds
- population 60 patients with open post-operative PS wounds
- intervention the first group received LIE ointment treatment
- comparator the second group used phenytoin as a standard occlusive dressing method and the third group used eucerin ointment as a negative control
- primaryOutcome A physician measured the length, depth and volume of the wounds on days 7, 14 and 28 post-PS surgery
- result After two weeks, the LIE topical ointment significantly decreased the length and depth of the wound compared to phenytoin and eucerin ointments. Additionally, the wound volume in the LIE-treated group was substantially lower than in the other groups (P < 0.05).
Indian J Dermatol · PMID 40740394 · Read it on PubMed ↗
Anorectal Branch of Chinese Medical Doctor Association et al. 2023
[Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)]
Expert guideline, no cream outcome data.GuidelineVery low qualityRelated question
size not given2023
expert consensus on diagnosis and treatment, not a study of treatment effectiveness
Who was studied
people with sacrococcygeal pilonidal disease (a cyst/sinus near the tailbone)
What they received
various treatments including hair removal, surgery, and non-surgical treatment
Compared with
different treatment options compared to each other
Main outcome
best approach to diagnosis and treatment
Quality
This is an expert opinion consensus document, not original research measuring treatment outcomes.
Limitations
This is a consensus statement summarizing expert opinion and existing literature, not a new study with its own results or data on cream treatment specifically.
Taken word for word from the abstract
- population Sacrococcygeal pilonidal disease(SPD) is an acquired disease intimately related to the presence of hair in the gluteal groove.
- intervention numerous treatment options are available for SPD including gluteal groove and surrounding skin hair removal, sinusectomy, open healing by secondary intention, primary closure, and local excision with flap reconstruction
- comparator non-surgical treatment, surgical treatment, minimally invasive treatment, and wound management
- primaryOutcome to improve the diagnosis and treatment of SPD
- result developed the "Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)" after rounds of discussion and revision
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 37974345 · Read it on PubMed ↗
Esposito et al. 2020
Standardization of Pre- and Postoperative Management Using Laser Epilation and Oxygen-Enriched Oil-Based Gel Dressing in Pediatric Patients Undergoing Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT)
Faster healing, fewer recurrences, with surgery.RetrospectiveLow qualityRelated question
87 people2020
Patients who got laser hair removal and the oil-based gel dressing healed faster and had fewer recurrences and infections than those who got the spray dressing alone
Who was studied
children and teenagers (12-18 years old) with chronic pilonidal sinus disease undergoing endoscopic surgery
What they received
laser hair removal plus oxygen-enriched oil-based gel dressing before and after surgery
Compared with
silver sulfadiazine spray dressing after surgery only
Main outcome
wound healing time, disease recurrence, and wound infection rate after endoscopic pilonidal sinus surgery
Quality
This was a retrospective comparison of two groups treated at different time periods, not a randomized trial, so other differences between groups could explain the results.
Limitations
Retrospective design comparing two different time-period protocols rather than a randomized trial; this study is about a surgical adjunct (dressing plus laser hair removal) after endoscopic surgery, not a cream used alone to treat the cyst without surgery.
Taken word for word from the abstract
- n We retrospectively reviewed the data of 87 pediatric patients
- population pediatric patients, 52 boys and 35 girls, with an average age of 17.1 years (range, 12-18) affected by chronic PSD
- intervention G1 (n = 47) treated with pre- and postoperative LE and oxygen-enriched oil-based gel dressing
- comparator G2 (n = 40) treated with only postoperative dressing using silver sulfadiazine spray
- primaryOutcome compared regarding the operative outcome, wound-healing time, disease recurrence, wound infections, and other complications
- result The median healing time significantly decreased in G1 (21 days) compared with G2 (28.1 days) (P = 0.001]. The disease recurrence rate was significantly lower in G1 (n = 1, 2.1%) compared with G2 (n = 6, 15%) (P = 0.001), and the wound infection rate was significantly lower in G1 (n = 1, 2.1%) compared with G2 (n = 4, 10%) (P = 0.001).
Lasers Surg Med · PMID 32964496 · Read it on PubMed ↗
Esposito et al. 2020
Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT) in Children With Pilonidal Sinus Disease: Tips and Tricks and New Structurated Protocol
Better post-surgery healing with oil gel dressingRetrospectiveLow qualityRelated question
127 people2020
the oil-based gel dressing group had a higher success rate (98.6% vs 90.9%), lower recurrence (1.4% vs 9%), faster healing (21 vs 29 days) and higher satisfaction than the spray dressing group
Who was studied
children and teenagers who had surgery for pilonidal sinus disease
What they received
oxygen-enriched oil-based gel dressing applied after endoscopic pilonidal surgery and laser hair removal
Compared with
silver sulfadiazine spray dressing after the same surgery
Main outcome
treatment success rate, recurrence, wound infection, healing time and patient satisfaction after surgery
Quality
this is a retrospective, non-randomized comparison of a wound dressing used only after surgery, not a test of cream as a standalone treatment.
Limitations
retrospective design, no randomization, and the cream/gel was only an adjunct to surgery rather than a treatment for the cyst itself
Taken word for word from the abstract
- n We retrospectively reviewed the data of 127 pediatric patients, who underwent PEPSiT for PSD in our institutions over a 36-month period.
- population 127 pediatric patients, who underwent PEPSiT for PSD
- intervention G1 (laser + oxygen-enriched oil-based gel dressing) included 72 patients
- comparator G2 (laser + silver sulfadiazine spray dressing) included 55 patients
- primaryOutcome compared regarding success rate, recurrence, wound infection rate, wound healing time, post-operative outcome, time to full daily activities and patient satisfaction
- result The overall success rate was significantly higher in G1 (n = 71, 98.6%) compared with G2 (n = 50, 90.9%) [p = 0.001]. The recurrence rate was also significantly lower in G1 (n = 1, 1.4%) compared with G2 (n = 5, 9%) [p = 0.001]. Furthermore, G1 reported a faster wound healing (average 21 days) compared with G2 (average 29 days) [p = 0.001] and a higher patient satisfaction score (average 4.9) compared with G2 (average 4.2) [p = 0.001].
Front Pediatr · PMID 32671004 · Read it on PubMed ↗
McNamara et al. 2020
Traditional and advanced therapeutic modalities for wounds in the paediatric population: an evidence-based review
No specific finding reported.Narrative reviewLow qualityRelated question
size not given2020
The abstract does not report any specific finding about cream treatment for pilonidal cyst or sinus
Who was studied
children with non-healing wounds from various causes, including pilonidal disease
What they received
various wound care treatments such as dressings, topical remedies, and skin substitutes
Quality
It is a general narrative review of paediatric wound care without a defined outcome or data on pilonidal cyst cream treatment.
Limitations
The abstract admits that high-tier evidence in paediatric wound populations is scarce and does not address pilonidal cyst/sinus cream treatment specifically.
Taken word for word from the abstract
- population Children can have non-healing wounds due to a wide range of pathologies, including epidermolysis bullosa (EB), pilonidal disease and Stevens-Johnson syndrome
- intervention Various topical formulations are also described, including the need to use antibiotics judiciously.
- result Advancements in wound care are rapidly expanding. Various treatments for non-healing wounds in paediatric and neonatal patients have been reported, but high tier evidence in these populations is scarce.
J Wound Care · PMID 32530778 · Read it on PubMed ↗
Demirel et al. 2019
Long-Term Outcomes of Crystallized Phenol Application after Punch Excision for the Treatment of Pilonidal Sinus Disease
Low recurrence after phenol plus excision.Case seriesLow qualityRelated question
size not given16 to 38 months (mean 23.7 months)
About 12% of patients had recurrence early on and about 13% had recurrence at long-term follow-up (mean 23.7 months)
Who was studied
people with pilonidal sinus disease treated with a punch biopsy procedure
What they received
crystallized phenol applied into the sinus cavity after punch excision of the opening
Compared with
no comparison group; outcomes tracked over time within the same patients
Main outcome
recurrence of the pilonidal sinus after treatment
Quality
This is a small, uncontrolled case series without a comparison group, so it can't show whether the treatment truly worked better than doing nothing or using surgery.
Limitations
No control group, no randomization, and the total number of patients enrolled at baseline is not clearly stated; this involves a surgical punch excision combined with a chemical agent, not a standalone topical cream.
Taken word for word from the abstract
- population the treatment of pilonidal sinus disease
- intervention a punch biopsy tool is used for the excision of the sinus opening holes; after cleaning the cavity, 150 to 250 mg of crystallized phenol was administered
- comparator it can successfully be applied without the need for surgical intervention
- primaryOutcome Recurrence was detected in five patients (11.9%)
- result In the long-term results, 39 patients were available after 16 to 38 months (mean 23.7 months). Of these, recurrence was detected in five patients (12.8%).
- followUp 16 to 38 months (mean 23.7 months)
Am Surg · PMID 31775962 · Read it on PubMed ↗
Sibbald et al. 2018
Evaluating a Surfactant-Containing Polymeric Membrane Foam Wound Dressing with Glycerin in Patients with Chronic Pilonidal Sinus Disease
Most wounds closed with dressing.Case seriesVery low qualityRelated question
16 people12 weeks
At 12 weeks, 10 of 16 wounds (63%) had closed, 1 had shrunk, 2 had grown larger, and 3 patients dropped out
Who was studied
adults aged 18 to 49 with chronic, non-healing pilonidal sinus wounds lasting more than 4 weeks
What they received
a surfactant-containing polymeric membrane foam wound dressing with glycerin applied daily
Compared with
no comparator group; single-arm observational study
Main outcome
wound closure after 12 weeks of treatment
Quality
This was a small, uncontrolled case series with no comparison group and some patients lost to follow-up, so it cannot show whether the dressing itself caused the healing.
Limitations
No control group, small sample size, and nearly a fifth of patients lost to follow-up.
Taken word for word from the abstract
- n Sixteen patients aged between 18 and 49 years with chronic nonhealing pilonidal sinus wounds over 4 weeks in duration were recruited.
- population patients aged between 18 and 49 years with chronic nonhealing pilonidal sinus wounds over 4 weeks in duration
- intervention a surfactant-containing polymeric wound dressing with glycerin
- comparator This case series was conducted in an outpatient dermatology and wound clinic.
- primaryOutcome To evaluate the clinical use of a surfactant-containing polymeric wound dressing with glycerin in patients with chronic pilonidal sinus wounds.
- result At week 12, 10 wounds (63%) had closed, 1 (6%) had decreased in surface area, 2 (13%) had increased in size, and 3 (19%) of the patients were lost to follow-up.
- followUp Patients were seen at follow-up visits to the clinic at weeks 4, 8, and 12 from study initiation.
Adv Skin Wound Care · PMID 29923900 · Read it on PubMed ↗
Ates et al. 2018
Pilonidal sinus disease surgery in children: the first study to compare crystallized phenol application to primary excision and closure
Phenol may work, shorter follow-up though.RetrospectiveLow quality
117 people8.1 (1-19) months for phenol group; 44.6 (8-82) months for excision and closure group
phenol group had shorter hospital stay and seemed to have lower recurrence and complication rates, but follow-up time differed greatly between groups
Who was studied
children and teenagers with pilonidal sinus disease
What they received
crystallized phenol application
Compared with
surgical excision with primary closure
Main outcome
recurrence and complication rates, hospital stay
Quality
This was a retrospective study with very different follow-up times between groups, so the comparison is not reliable.
Limitations
Retrospective data; follow-up was much shorter for the phenol group (8.1 months) than the surgery group (44.6 months)
Taken word for word from the abstract
- n This study included 117 patients with PS.
- population This retrospective study included pediatric patients with PS
- intervention crystallized phenol application
- comparator excision and primer closure technique
- primaryOutcome crystallized phenol application seems a feasible minimal invasive alternative to primary closure of PS with lower recurrence and complication rates in children
- result crystallized phenol application seems a feasible minimal invasive alternative to primary closure of PS with lower recurrence and complication rates in children
- followUp Mean follow up was 44.6 (8-82) months for primary excision and closure group and 8.1 (1-19) months for phenol group.
J Pediatr Surg · PMID 28549686 · Read it on PubMed ↗
Yuksel 2017
Pilonidal sinus disease can be treated with crystallized phenol using a simple three-step technique
Mostly healed sinus with phenol.Case seriesLow qualityRelated question
50 people2017
88% of patients were cured after a single application
Who was studied
patients with pilonidal sinus disease
What they received
crystallized phenol applied into the sinus opening using a three-step technique
Compared with
none (no comparison group, single-arm treatment)
Main outcome
closure of pilonidal sinus openings without leakage (healing)
Quality
This was a small, uncontrolled case series without a comparison group, so it can't show whether phenol works better than other treatments.
Limitations
No control group, small sample, and treatment failures occurred especially after prior surgery or wound infection.
Taken word for word from the abstract
- n 43 male and 7 female patients with pilonidal sinus disease were treated with crystallized phenol
- population patients with pilonidal sinus disease
- intervention the pilonidal sinus openings were gently filled with crystallized phenol
- comparator 43 male and 7 female patients with pilonidal sinus disease were treated with crystallized phenol
- primaryOutcome The closure of pilonidal sinus openings without any leakage after a single application of crystallized phenol was accepted as healing.
- result The overall cure rate was 88%.
Acta Dermatovenerol Alp Pannonica Adriat · PMID 28352930 · Read it on PubMed ↗
Bayhan et al. 2016
Crystallized phenol application and modified Limberg flap procedure in treatment of pilonidal sinus disease: A comparative retrospective study
Similar cure rates, fewer complications with phenol.RetrospectiveLow qualityRelated question
81 people2016
Phenol group had shorter hospital stay and fewer wound problems, but recurrence rates were not significantly different between groups; repeated phenol treatments raised success to 94.5%
Who was studied
patients diagnosed with pilonidal sinus disease
What they received
crystallized phenol application (a chemical treatment applied to the sinus)
Compared with
modified Limberg flap surgery
Main outcome
hospital stay, wound complications, and recurrence rate
Quality
This was a retrospective, non-randomized comparison of two small patient groups, so differences could be due to other factors rather than the treatment itself.
Limitations
Retrospective design, no randomization, relatively small groups (37 vs 44 patients), and outcome depended on multiple treatment sessions.
Taken word for word from the abstract
- population Thirty-seven patients diagnosed with pilonidal sinus and treated with modified Limberg flap reconstruction, and 44 patients treated with crystallized phenol application were evaluated retrospectively
- intervention crystallized phenol application
- comparator modified Limberg flap reconstruction
- primaryOutcome length of stay in hospital postoperatively, wound complications, and the cause and rate of recurrence
- result Length of hospital stay was decreased and no postoperative incision problems were found in the group treated with crystallized phenol application (p < 0.001 and p = 0.011, respectively). The difference between the groups in terms of recurrence rate was not statistically significant (p = 0.173).
- result the success rate following multiple applications of crystallized phenol was found to be 94.5%
- n Thirty-seven patients diagnosed with pilonidal sinus and treated with modified Limberg flap reconstruction, and 44 patients treated with crystallized phenol application
Asian J Surg · PMID 26883556 · Read it on PubMed ↗
Woo et al. 2015
Topical Agents and Dressings for Pilonidal Sinus Wound Healing by Secondary Intention: A Scoping Review
Weak, inconclusive evidence creams help healing.Systematic reviewVery low qualityRelated question
size not given2015
some evidence these topical treatments may help healing, reduce bacteria, or ease pain, but evidence is weak
Who was studied
people with pilonidal sinus wounds healing after surgery
What they received
topical agents or dressings (like hydrogel, silver, honey, zinc, foam, negative pressure therapy, platelet rich plasma, plant extracts)
Main outcome
wound healing by secondary intention
Quality
this is a scoping review of studies with acknowledged methodological limitations and biases, so the findings are not reliable evidence.
Limitations
abstract states evidence remains insufficient due to methodological limitations and biases of the included studies
Taken word for word from the abstract
- population which topical agent or dressing is effective in promoting pilonidal wound healing by secondary intention
- intervention hydrogel, silver, honey, zinc, selected foam materials, negative pressure wound therapy, platelet rich plasma, and plant extracts
- primaryOutcome promoting pilonidal wound healing by secondary intention
- result there is some evidence to suggest that topical applications of hydrogel, silver, honey, zinc, selected foam materials, negative pressure wound therapy, platelet rich plasma, and plant extracts may promote wound healing
- limitations evidence remains insufficient in light of methodological limitations and biases of the studies
Surg Technol Int · PMID 26054992 · Read it on PubMed ↗
Girgin et al. 2012
Minimally invasive treatment of pilonidal disease: crystallized phenol and laser depilation
No recurrence after phenol plus laserCase seriesLow qualityRelated question
42 peoplemean 24 months (range, 6-30 months)
About 62% healed after one phenol treatment, the rest after repeated treatments, and no recurrences were seen over a mean 24 months of follow-up
Who was studied
patients with chronic or recurrent pilonidal disease
What they received
crystallized phenol treatment combined with alexandrite laser hair removal
Compared with
none (single group, no control treatment)
Main outcome
complete healing and recurrence of pilonidal disease after treatment
Quality
This was a small retrospective case series with no comparison group, so it can't show whether the treatment worked better than other options.
Limitations
Retrospective design, no control group, small sample size, some patients needed up to 8 repeat treatments.
Taken word for word from the abstract
- n In total, 42 (31 male and 11 female) patients were treated with crystallized phenol and alexandrite laser depilation
- population 38 patients (90.5%) had chronic disease and 4 (9.5%) had recurrent disease
- intervention Patients who were treated with crystallized phenol and 755-nm alexandrite laser depilation were retrospectively analyzed.
- comparator Patients who were treated with crystallized phenol and 755-nm alexandrite laser depilation were retrospectively analyzed.
- primaryOutcome None of the patients had a recurrence during a mean 24 months (range, 6-30 months) of follow-up.
- result Among the patients, 26 (61.9%) recovered following 1 crystallized phenol treatment, and the remaining patients had complete remission following repeated treatment.
Int Surg · PMID 23294066 · Read it on PubMed ↗
Thomas et al. 2011
Manuka honey as an effective treatment for chronic pilonidal sinus wounds
Most wounds healed with honey.RetrospectiveVery low quality
17 people2011
15 of 17 patients healed completely, average 65 days; 2 had recurrence
Who was studied
patients with chronic or recurrent pilonidal sinus disease after surgery
What they received
manuka honey dressing applied to the wound
Compared with
no comparison group
Main outcome
complete wound healing and time to heal
Quality
small retrospective case series with no comparison group, so it cannot show honey worked better than standard care alone.
Limitations
Retrospective design, no control group, small sample, one patient stopped due to adverse event.
Taken word for word from the abstract
- n Seventeen patients were eligible for inclusion in the study.
- population patients who received manuka honey dressing therapy following surgical intervention for chronic or recurrent PSD
- intervention topical manuka honey in the treatment of chronic or recurrent pilonidal sinus disease
- comparator A retrospective study to investigate the effectiveness of topical manuka honey
- primaryOutcome assessing the ability of this simple dressing technique to achieve complete wound healing, the time taken to achieve healing and the recurrence rate
- result 15 patients achieved complete wound healing, in a mean time of 65 days (14-264 days; median 49 days). Honey was discontinued in one patient due to an adverse event, and two patients experienced recurrence several months after completing honey therapy.
J Wound Care · PMID 22240847 · Read it on PubMed ↗
Saraceno et al. 2009
Methyl aminolaevulinate photodynamic therapy for the treatment of hidradenitis suppurativa and pilonidal cysts
Mostly cleared skin lesions, one patient.Case seriesVery low qualityRelated question
1 people6-month follow-up
achieved almost complete clinical remission (80%) of skin lesions and complete resolution of itching and discomfort
Who was studied
29-year-old man with hidradenitis suppurativa and pilonidal cysts since age 21
What they received
photodynamic therapy using topical methyl aminolaevulinate (MAL) cream applied with occlusive dressing and red light
Compared with
previous treatments: antibiotics, corticosteroids and retinoids
Main outcome
clinical improvement of skin lesions and symptoms
Quality
This is a single patient case report with no control group, so it cannot show whether the cream actually caused the improvement.
Limitations
Only one patient was treated, there was no comparison group, and the therapy required many costly sessions.
Taken word for word from the abstract
- n the case of a 29-year-old man
- population a 29-year-old man affected by HS and pilonidal cysts since the age of 21
- intervention A topical MAL cream (Metvix) was applied to the affected areas with an occlusive dressing for 3 h and irradiated with a red light source.
- comparator the patient was treated with antibiotics, corticosteroids and retinoids, without significant clinical improvement
- primaryOutcome achieved an almost complete clinical remission of the skin lesions (80%) and complete resolution of the itching and discomfort
- result achieved an almost complete clinical remission of the skin lesions (80%) and complete resolution of the itching and discomfort
- followUp The patient completed a 6-month follow-up
Photodermatol Photoimmunol Photomed · PMID 19438999 · Read it on PubMed ↗
Aldemir et al. 2003
Effectiveness of collagenase in the treatment of sacrococcygeal pilonidal sinus disease
Faster wound healing after surgery.Randomised trialLow qualityRelated question
40 people2003
faster healing and smaller wound with collagenase dressing
Who was studied
patients with pilonidal sinus disease at the tailbone
What they received
excision and marsupialization with collagenase dressing
Compared with
excision and marsupialization without collagenase dressing
Main outcome
wound healing speed and size
Quality
Small trial of only 40 patients, so the results may not be reliable.
Limitations
Small sample size; after surgical excision rather than cream alone; no mention of blinding.
Taken word for word from the abstract
- n 40 patients admitted to our department were separated into two groups
- population Sacrococcygeal pilonidal sinus disease (SPSD) is a disease affecting young patients
- intervention Excision and marsupialization with dressing by bacterial collagenase was performed in the first group
- comparator the treatment was excision and marsupialization without dressing by bacterial collagenase in the second group
- primaryOutcome healing in terms of the width and depth of the wound in the first week and in depth of wound in the second week
- result The duration of wound healing was 21.9 +/- 1.3 days in group 1, and 28.1 +/- 1.3 days in group 2 ( P = 0.0001).
Surg Today · PMID 12616370 · Read it on PubMed ↗
Fernandez et al. 2002
Efficacy of Rhizophora mangle aqueous bark extract in the healing of open surgical wounds
Faster wound shrinkage than mercurochromeRandomised trialLow qualityRelated question
37 people6 weeks
wounds treated with the bark extract shrank more than those treated with mercurochrome
Who was studied
patients with open wounds after surgery for pilonidal cyst or pilonidal fistula
What they received
topical Rhizophora mangle aqueous bark extract applied once or twice daily
Compared with
mercurochrome applied twice daily
Main outcome
reduction in wound area over 6 weeks after surgery
Quality
Small trial of only 37 people measuring wound size rather than patient-centered healing or recurrence outcomes.
Limitations
Small sample size; outcome measured only as wound area by imaging, not infection, recurrence, or patient comfort; abstract does not describe blinding details or dropout.
Taken word for word from the abstract
- n Thirty-seven patients with open wounds from surgical intervention of pilonidal cyst (14; 37.8%) or pilonidal fistula (23; 62.2%) were enrolled
- population patients with open wounds from surgical intervention of pilonidal cyst (14; 37.8%) or pilonidal fistula (23; 62.2%)
- intervention randomly assigned to a topical treatment with a Rhizophora mangle aqueous bark extract once a day or twice a day
- comparator or mercurocrome twice a day
- primaryOutcome The efficacy of the treatments was evaluated weekly from day 10 to 12 until 6 weeks after surgery by measuring the area of the wounds by image digital planimetry
- result The wound areas of the groups treated with the extract once or twice per day showed a greater reduction (P < 0.05) compared to the group treated with mercurocrome.
Fitoterapia · PMID 12490213 · Read it on PubMed ↗
O'Meara et al. 2001
Systematic review of antimicrobial agents used for chronic wounds
No real evidence on creams for pilonidal sinusSystematic reviewLow qualityRelated question
size not given2001
systemic antibiotics not supported for leg ulcers or diabetic foot ulcers but may help as an add-on to surgery for pilonidal sinuses; some topical agents may help generally
Who was studied
people with chronic wounds (leg ulcers, diabetic foot ulcers, pilonidal sinuses)
What they received
antimicrobial agents, including systemic antibiotics and topical preparations
Main outcome
wound healing
Quality
This is a narrative (not statistical) review of small, methodologically weak trials, so the pilonidal-specific finding is only a tentative observation.
Limitations
Small sample sizes and other methodological problems in included trials; findings often difficult to interpret; narrative overview rather than pooled analysis; results require replication in larger, well-designed studies.
Taken word for word from the abstract
- population recruited participants with chronic wounds
- intervention antimicrobial agents are evaluated
- primaryOutcome incorporated an objective assessment of wound healing
- result Results do not support the routine use of systemic antibiotics for leg ulcers or diabetic foot ulcers without acute infection, but they may be useful as an adjunct to surgery for pilonidal sinuses.
- result Several topical preparations may be helpful, including dimethyl sulphoxide, silver sulphadiazine, benzoyl peroxide, oxyquinoline and gentamicin.
- limitations Small sample size and other methodological problems meant that findings were often difficult to interpret.
Br J Surg · PMID 11136304 · Read it on PubMed ↗
O'Meara et al. 2000
Systematic reviews of wound care management: (3) antimicrobial agents for chronic wounds; (4) diabetic foot ulceration
No pilonidal-specific result reportedSystematic reviewVery low qualityRelated question
size not given2000
abstract ends before reporting any specific antimicrobial results for pilonidal sinus patients
Who was studied
people with chronic wounds, including pilonidal sinuses
What they received
topical (and systemic) antimicrobial agents for chronic wounds
Compared with
trials with a concurrent control group (type not specified for pilonidal sinus studies)
Main outcome
healing rates and recurrence of disease for pilonidal sinuses
Quality
The review only lists pilonidal sinus as one of several eligible wound types and the text is truncated before giving any specific findings for it, while the overall included studies were judged to be of generally poor methodological quality.
Limitations
Methodological and reporting quality was generally poor, with unclear randomisation, lack of blinded outcome assessment, no adjustment for baseline wound size differences, large losses to follow-up, and no intention-to-treat analysis.
Taken word for word from the abstract
- population diabetic foot ulcers, pressure ulcers, leg ulcers of various aetiologies, pilonidal sinuses, non-healing surgical wounds, and cavity wounds
- intervention systemic and topical antimicrobial agents in the prevention and healing of chronic wounds
- comparator Randomised and non-randomised trials with a concurrent control group
- primaryOutcome healing rates and recurrence of disease, among others, for pilonidal sinuses
- result (ABSTRACT TRUNCATED)
- quality The methodological and reporting quality was generally poor.
Health Technol Assess · PMID 11074391 · Read it on PubMed ↗
Palmieri et al. 1994
[Pilonidal cysts: the state of the art and the authors' personal experiences]
Cream only minor add-on, not tested aloneRetrospectiveVery low qualityRelated question
53 peopleat least 12 months
patients healed in 4 weeks to 2 months and no relapses were seen for at least 12 months after the second treatment, but the cream was only a minor add-on to surgery and dressings, not tested on its own
Who was studied
patients with pilonidal cyst, average age 23, treated in a surgery department
What they received
surgery under anaesthesia plus antibiotics, methylene blue injection, and for relapses an open wound protocol using collagen and silver sulfadiazine with a depilating cream suggested for the wound border
Compared with
no comparison group; patients compared before and after treatment, and relapsed cases treated again
Main outcome
whether the wound healed and whether the cyst came back after treatment
Quality
this is a small retrospective case series without a control group, and the cream was just one small part of a larger surgical and dressing protocol, so its own effect cannot be judged.
Limitations
retrospective design, no comparison group, very small number of relapsed patients, and the cream was combined with surgery and other dressings so its individual effect is not separable
Taken word for word from the abstract
- n This study involved 53 patients (35 males and 15 females, 23 years average age) affected by pilonidal cyst.
- population 53 patients (35 males and 15 females, 23 years average age) affected by pilonidal cyst
- intervention These patients were treated for a month with antibiotic therapy and underwent surgery by general anaesthesia.
- intervention they followed an open treatment protocol including collagen and silver sulfadiazine, healing by delayed wound closure. Furthermore a depilating cream for the border of the wound was suggested to the patient.
- comparator Between 4 months and 2 years 5.7% of operated patients relapsed.
- primaryOutcome These patients healed in a period between 4 weeks and 2 months. No relapses were observed after at least 12 months.
- result These patients healed in a period between 4 weeks and 2 months. No relapses were observed after at least 12 months.
Minerva Chir · PMID 7970033 · Read it on PubMed ↗
Marks et al. 1987
Staphylococcal infection of open granulating wounds
Cream treated armpit infections, not pilonidal cysts.Prospective cohortLow qualityRelated question
250 people1987
Infected armpit wounds healed well with Fucidin ointment, but pilonidal sinus wounds showed no clear harm from the same bacteria and were not reported as treated with cream
Who was studied
people with surgical wounds healing by open granulation, including armpit skin removal, abdominal surgery, and pilonidal sinus removal
What they received
Fucidin (fusidic acid) ointment used to treat infected armpit wounds
Compared with
not stated
Main outcome
whether Staphylococcus aureus infection caused pain and delayed wound healing
Quality
This is an observational study of wound infection, not a trial testing cream treatment for pilonidal sinus specifically.
Limitations
No control group, no randomisation, and the cream treatment described applies to a different wound type (armpit) rather than pilonidal sinus wounds.
Taken word for word from the abstract
- n 250 wounds healing by open granulation
- population 50 axillary skin excisions
- population 50 laparotomy wounds and 150 pilonidal sinus excisions studied
- intervention The infections responded well to Fucidin ointment.
- primaryOutcome 17 became infected with Staphylococcus aureus with consequent pain and delay in healing
- result there was no clear evidence of harm resulting in the 50 laparotomy wounds and 150 pilonidal sinus excisions studied
- comparator The significance of staphylococcal infection has been studied prospectively in 250 wounds healing by open granulation.
Br J Surg · PMID 3815041 · Read it on PubMed ↗

How we searchedThe exact query, the date it ran, and what came back — so you can run it yourself.

Searched: PubMed · ClinicalTrials.gov · Crossref on 2026-10-05
The exact search — paste this into PubMed to repeat it: ("Pilonidal Sinus"[Mesh] OR pilonidal[tiab]) AND ("Ointments"[Mesh] OR "Administration, Topical"[Mesh] OR "Anti-Infective Agents, Local"[Mesh] OR cream[tiab] OR ointment[tiab] OR topical[tiab] OR depilatory[tiab] OR "hair removal"[tiab]); PubMed expanded that to: ("Pilonidal Sinus"[MeSH Terms] OR "pilonidal"[Title/Abstract]) AND ("Ointments"[MeSH Terms] OR "administration, topical"[MeSH Terms] OR "anti infective agents, local"[MeSH Terms] OR "cream"[Title/Abstract] OR "ointment"[Title/Abstract] OR "topical"[Title/Abstract] OR "depilatory"[Title/Abstract] OR "hair removal"[Title/Abstract])
What came back: 101 records found · 99 read · 26 answered the question
Included: Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded: Records about a different condition or intervention
Records reporting no outcome
Retracted publications, which are listed but excluded from every count
Limits: Details were read from abstracts, not full papers, so anything reported only in a paper's methods section is not captured here.
Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.
Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.

101records came back from the search
99were read
26actually answered the question

Why people try thisThe reasoning behind the question — not a claim that it works.

Surgery for a pilonidal cyst sounds scary and painful, so a cream feels like an easier first step.
Creams are cheap, available without a prescription, and can be used at home without seeing a doctor.
Marketing for 'natural' or herbal creams promises healing without a procedure.
People hope that if the cyst looks smaller or less red after using a cream, it means it's going away for good.

Common questionsShort answers, drawn from the same studies.

Can I treat my pilonidal cyst with cream instead of surgery?: No trial has tested using a cream alone to treat an intact pilonidal cyst or sinus instead of surgery. Every study here looked at creams used on wounds after surgery, or alongside other treatments. If you have a painful or draining cyst, see a doctor — cream alone is unlikely to fix it.
Does zinc oxide cream help pilonidal wounds heal faster?: Two placebo-controlled trials tested zinc oxide cream on open wounds after pilonidal surgery and found no meaningful difference in healing time. One of them did find that zinc reduced bacterial infection, even though it didn't speed up closing of the wound.
Do hair-removal creams stop the cyst from coming back?: The evidence is mixed. One study found depilatory cream combined with another treatment reduced recurrence, but a larger review found razor or cream hair removal led to more recurrences than no hair removal, with laser hair removal doing better than either.
Should I stop using the cream my doctor prescribed?: Don't stop a prescribed treatment without checking with your doctor first. Some creams used as part of wound care after surgery may still have a role, even though the evidence behind them is weak.
What actually works for a pilonidal cyst or sinus?: Based on this search, surgical removal, drainage of an abscess, and minimally invasive options like crystallized phenol injection have the strongest evidence. Cream has not been shown to be a proven substitute for these treatments.

This is information, not advice

This page summarises published research. It cannot tell you what is happening in your own body, and evidence changes. If something is bleeding, painful, or new, it is worth being looked at — that is a different question from the one on this page, and a better one to bring to a consultation.

Contact the office

Automated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.

Allen Kamrava, MD, MBA, FACS, FASCRS · 435 N. Bedford Dr., Suite 308, Beverly Hills, CA 90210 · 424.279.8222

Educational information — not medical advice.