{ "slug": "cream-pilonidal", "question": "Can a cream treat a pilonidal cyst or sinus?", "shortTitle": "Cream for a Pilonidal Cyst?", "clinicalQuestion": "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?", "pico": { "population": "People with a pilonidal cyst or pilonidal sinus disease (acute abscess or chronic sinus)", "intervention": "Topical cream applied to the affected area (antiseptic cream, antibiotic cream, or hair-removal/depilatory cream)", "comparator": "No cream, standard wound care, or surgical management alone", "outcomes": [ "lesion or wound healing rate", "symptom resolution (pain, discharge, swelling)", "recurrence rate", "need for surgical intervention", "time to healing", "adverse skin reactions" ] }, "category": "anorectal", "relatedConditions": [ "pilonidal-cyst", "pilonidal-sinus" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "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.", "detail": "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.", "studyIds": [ "pmid:35593897", "pmid:23595590", "pmid:17014663" ] }, "strength": { "level": "moderate", "why": "One well-conducted randomised trial addresses this question directly.", "override": null }, "direction": { "level": "no-meaningful-benefit", "why": "Most of the evidence found no meaningful difference.", "override": null }, "counts": { "recordsRetrieved": 101, "recordsScreened": 99, "included": 26, "rcts": 5, "systematicReviews": 5, "observational": 8, "participants": 3001, "yearFrom": 1987, "yearTo": 2025, "registeredTrialsWithoutResults": 0 }, "excluded": [], "outcomes": [ { "name": "Healing of an intact cyst or sinus without surgery", "status": "not-studied", "note": "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.", "studyIds": [ "pmid:31616217", "pmid:29923900" ] }, { "name": "Wound healing speed after surgery", "status": "insufficient", "note": "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.", "studyIds": [ "pmid:35593897", "pmid:23595590", "pmid:17014663", "pmid:12616370", "pmid:40740394", "pmid:12490213" ] }, { "name": "Avoiding the need for surgery by using cream", "status": "not-studied", "note": "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.", "studyIds": [] }, { "name": "Symptom relief (pain, discharge, swelling)", "status": "insufficient", "note": "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.", "studyIds": [ "pmid:31616217" ] }, { "name": "Skin reactions to the cream", "status": "insufficient", "note": "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.", "studyIds": [ "pmid:22240847" ] } ], "benefits": [ { "text": "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.", "studyIds": [ "pmid:35593897" ] }, { "text": "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.", "studyIds": [ "pmid:33915547" ] } ], "limitations": [ { "text": "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.", "studyIds": [ "pmid:40740394", "pmid:35593897", "pmid:23595590", "pmid:17014663", "pmid:12616370", "pmid:12490213", "pmid:7970033" ] }, { "text": "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.", "studyIds": [ "pmid:31616217", "pmid:29923900", "pmid:28352930", "pmid:23294066", "pmid:22240847", "pmid:19438999" ] }, { "text": "Sample sizes are often very small, sometimes under 20 people, so chance alone could easily explain the differences reported.", "studyIds": [ "pmid:23595590", "pmid:22240847", "pmid:19438999", "pmid:12490213" ] }, { "text": "Most studies are low or very low quality, with retrospective designs and no blinding, which makes it hard to trust the reported benefits.", "studyIds": [ "pmid:33915547", "pmid:32964496", "pmid:32671004", "pmid:31775962", "pmid:29185064", "pmid:28549686", "pmid:26883556" ] } ], "risks": [], "whyPeopleTryIt": [ { "text": "Surgery for a pilonidal cyst sounds scary and painful, so a cream feels like an easier first step." }, { "text": "Creams are cheap, available without a prescription, and can be used at home without seeing a doctor." }, { "text": "Marketing for 'natural' or herbal creams promises healing without a procedure." }, { "text": "People hope that if the cyst looks smaller or less red after using a cream, it means it's going away for good." } ], "keyStudies": [ "pmid:35593897", "pmid:23595590", "pmid:17014663", "pmid:33915547", "pmid:29185064", "pmid:31616217" ], "studies": [ { "id": "pmid:40740394", "pmid": "40740394", "doi": "10.4103/ijd.ijd_673_24", "nctId": null, "pmcid": "PMC12306878", "title": "Wound-Healing Properties of Henna in Pilonidal Sinus Surgery: A Randomized Study", "firstAuthor": "Khosravi", "multipleAuthors": true, "journal": "Indian J Dermatol", "year": 2025, "design": "rct", "n": 60, "nField": "reported", "population": "patients with open wounds after surgery for pilonidal sinus", "intervention": "henna (Lawsonia inermis extract) ointment applied to the wound", "comparator": "phenytoin ointment or eucerin ointment (inactive control)", "primaryOutcome": "wound length, depth and volume measured after surgery", "result": "henna ointment reduced wound length, depth and volume more than phenytoin or eucerin after two weeks", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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", "followUp": "28", "plainFinding": "Faster wound healing after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40740394/", "sourceText": "BACKGROUND: Wound complications associated with pilonidal sinus (PS) significantly contribute to its high post-operative morbidity. Therefore, speeding up the wound healing process after surgery can help minimize potential complications. This study investigated the effectiveness of Lawsonia inermis extract (LIE) in promoting wound healing following PS surgery, given its known benefits in this area. METHODS: This randomized, double-blind, controlled clinical trial involved 60 patients with open post-operative PS wounds. Participants were randomly divided into three groups: the first group received LIE ointment treatment, the second group used phenytoin as a standard occlusive dressing method and the third group used eucerin ointment as a negative control. In all groups, the wound was cleansed with normal saline and dressed with wet gauze daily. A physician measured the length, depth and volume of the wounds on days 7, 14 and 28 post-PS surgery. RESULTS: 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). CONCLUSION: The study highlighted the wound-healing properties of henna extract. The results indicate that LIE ointment can enhance the wound healing process, thereby lowering the risk of infection and complications in post-operative wounds.", "provenance": [ { "field": "n", "quote": "involved 60 patients with open post-operative PS wounds" }, { "field": "population", "quote": "60 patients with open post-operative PS wounds" }, { "field": "intervention", "quote": "the first group received LIE ointment treatment" }, { "field": "comparator", "quote": "the second group used phenytoin as a standard occlusive dressing method and the third group used eucerin ointment as a negative control" }, { "field": "primaryOutcome", "quote": "A physician measured the length, depth and volume of the wounds on days 7, 14 and 28 post-PS surgery" }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:37974345", "pmid": "37974345", "doi": "10.3760/cma.j.cn441530-20231007-00116", "nctId": null, "pmcid": null, "title": "[Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)]", "firstAuthor": "Anorectal Branch of Chinese Medical Doctor Association", "multipleAuthors": true, "journal": "Zhonghua Wei Chang Wai Ke Za Zhi", "year": 2023, "design": "guideline", "n": null, "nField": "not-reported", "population": "people with sacrococcygeal pilonidal disease (a cyst/sinus near the tailbone)", "intervention": "various treatments including hair removal, surgery, and non-surgical treatment", "comparator": "different treatment options compared to each other", "primaryOutcome": "best approach to diagnosis and treatment", "result": "expert consensus on diagnosis and treatment, not a study of treatment effectiveness", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is an expert opinion consensus document, not original research measuring treatment outcomes.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Expert guideline, no cream outcome data.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37974345/", "sourceText": "Sacrococcygeal pilonidal disease(SPD) is an acquired disease intimately related to the presence of hair in the gluteal groove. Although its pathogenesis is still controversial, 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. Lacking of standardized diagnosis and treatment processes of SPD in China, Chinese Medical Doctor Association Anorectal Branch and its Clinical Guidelines Committee jointly organized experts in this field to form expert consensus opinion on the basis of summarizing latest research progress in China and abroad, experts' clinical experience and principles of evidence-based medicine. The expert group formed opinion in 12 terms of SPD diagnosis, risk factors, non-surgical treatment, surgical treatment, minimally invasive treatment, and wound management, and developed the \"Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)\" after rounds of discussion and revision, to improve the diagnosis and treatment of SPD.", "provenance": [ { "field": "population", "quote": "Sacrococcygeal pilonidal disease(SPD) is an acquired disease intimately related to the presence of hair in the gluteal groove." }, { "field": "intervention", "quote": "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" }, { "field": "comparator", "quote": "non-surgical treatment, surgical treatment, minimally invasive treatment, and wound management" }, { "field": "primaryOutcome", "quote": "to improve the diagnosis and treatment of SPD" }, { "field": "result", "quote": "developed the \"Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)\" after rounds of discussion and revision" } ] }, { "id": "pmid:35593897", "pmid": "35593897", "doi": "10.1002/14651858.CD013439.pub2", "nctId": null, "pmcid": "PMC9121912", "title": "Dressings and topical agents for the management of open wounds after surgical treatment for sacrococcygeal pilonidal sinus", "firstAuthor": "Herrod", "multipleAuthors": true, "journal": "Cochrane Database Syst Rev", "year": 2022, "design": "meta-analysis", "n": 205, "nField": "reported", "population": "young adults (mostly male) who had surgery for a pilonidal sinus and were left with an open wound to heal", "intervention": "Lietofix cream", "comparator": "an iodine dressing", "primaryOutcome": "proportion of wounds healed by 30 days", "result": "Lietofix cream may increase the proportion of wounds that heal by 30 days compared with an iodine dressing, based on one low-certainty trial", "resultDirection": "benefit", "quality": "low", "qualityWhy": "The finding comes from a single trial with high risk of bias, so confidence in the result is low.", "directness": "direct", "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.", "followUp": "30 days", "plainFinding": "Cream may speed wound healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35593897/", "sourceText": "BACKGROUND: Sacrococcygeal pilonidal sinus disease is a common debilitating condition that predominantly affects young adults, with a profound impact on their activities of daily living. The condition is treated surgically, and in some cases the wound in the natal cleft is left open to heal by itself. Many dressings and topical agents are available to aid healing of these wounds. OBJECTIVES: To assess the effects of dressings and topical agents for the management of open wounds following surgical treatment for sacrococcygeal pilonidal sinus in any care setting. SEARCH METHODS: In March 2021, we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and we scanned reference lists of included studies, reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We included parallel-group randomised controlled trials (RCTs) only. We included studies with participants who had undergone any type of sacrococcygeal pilonidal sinus disease surgery and were left with an open wound. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We included 11 RCTs comprising 932 participants. Two studies compared topical negative pressure wound therapy (TNPWT) with conventional open wound healing, two studies compared platelet-rich plasma with sterile absorbent gauze, and the other seven studies compared various dressings and topical agents. All studies were at high risk of bias in at least one domain, whilst one study was judged to be at low risk of bias in all but one domain. All studies were conducted in secondary care. Mean participant ages were between 20 and 30 years, and nearly 80% of participants were male. No studies provided data on quality of life, cost-effectiveness, pain at first dressing change or proportion of wounds healed at 6 or 12 months, and very few adverse effects were recorded in any study. It is unclear whether TNPWT reduces time to wound healing compared with conventional open wound healing (comparison 1), as the certainty of evidence is very low. The two studies provided conflicting results, with one study showing benefit (mean difference (MD) -24.01 days, 95% confidence interval (CI) -35.65 to -12.37; 19 participants), whilst the other reported no difference. It is also unclear whether TNPWT has any effect on the proportion of wounds healed by 30 days (risk ratio (RR) 3.60, 95% CI 0.49 to 26.54; 19 participants, 1 study; very low-certainty evidence). Limited data were available for our secondary outcomes time to return to normal daily activities and recurrence rate; we do not know whether TNPWT has any effect on these outcomes. 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). The study did not provide data on time to wound healing. We do not know whether hydrogel dressings reduce time to wound healing compared with wound cleaning with 10% povidone iodine (comparison 5; MD -24.54 days, 95% CI -47.72 to -1.36; 31 participants, 1 study; very low-certainty evidence). The study did not provide data on the proportion of wounds healed. It is unclear whether hydrogel dressings have any effect on adverse effects as the certainty of the evidence is very low. Platelet-rich plasma may reduce time to wound healing compared with sterile absorbent gauze (comparison 6; MD -19.63 days, 95% CI -34.69 to -4.57; 210 participants, 2 studies; low-certainty evidence). No studies provided data on the proportion of wounds healed. Platelet-rich plasma may reduce time to return to normal daily activities (MD -15.49, 95% CI -28.95 to -2.02; 210 participants, 2 studies; low-certainty evidence). Zinc oxide mesh may make little or no difference to time to wound healing compared with placebo (comparison 2; median 54 days in the zinc oxide mesh group versus 62 days in the placebo mesh group; low-certainty evidence). We do not know whether zinc oxide mesh has an effect on the proportion of wounds healed by 30 days as the certainty of the evidence is very low (RR 2.35, 95% CI 0.49 to 11.23). It is unclear whether gentamicin-impregnated collagen sponge reduces time to wound healing compared with no dressing (comparison 7; MD -1.40 days, 95% CI -5.05 to 2.25; 50 participants, 1 study; very low-certainty evidence). The study did not provide data on the proportion of wounds healed. Dialkylcarbamoyl chloride (DACC)-coated dressings may make little or no difference to time to wound healing compared with alginate dressings (comparison 8; median 69 (95% CI 62 to 72) days in the DACC group versus 71 (95% CI 69 to 85) days in the alginate group; 1 study, 246 participants; low-certainty evidence). One study compared a polyurethane foam hydrophilic dressing with an alginate dressing (comparison 3) whilst another study compared a hydrocolloid dressing with an iodine dressing (comparison 9). It is unclear whether either intervention has any effect on time to wound healing as the certainty of evidence is very low. AUTHORS' CONCLUSIONS: At present, the evidence that any of the dressings or topical agents contained in this review have a benefit on time to wound healing, the proportion of wounds that heal at a specific time point or on any of the secondary outcomes of our review ranges from low certainty to very low certainty. There is low-certainty evidence on the benefit on wound healing of platelet-rich plasma from two studies and of Lietofix cream and hydrogel dressings from single studies. Further studies are required to investigate these interventions further.", "provenance": [ { "field": "n", "quote": "205 participants, 1 study; low-certainty evidence" }, { "field": "intervention", "quote": "Lietofix cream" }, { "field": "comparator", "quote": "an iodine dressing" }, { "field": "primaryOutcome", "quote": "the proportion of wounds that heal by 30 days" }, { "field": "result", "quote": "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)." }, { "field": "population", "quote": "Mean participant ages were between 20 and 30 years, and nearly 80% of participants were male." }, { "field": "population", "quote": "participants who had undergone any type of sacrococcygeal pilonidal sinus disease surgery and were left with an open wound" } ] }, { "id": "pmid:33915547", "pmid": "33915547", "doi": "10.1159/000516903", "nctId": null, "pmcid": "PMC8562053", "title": "Is Hair Removal Necessary after Crystallized Phenol Treatment in Pilonidal Disease?", "firstAuthor": "Kargın", "multipleAuthors": true, "journal": "Med Princ Pract", "year": 2021, "design": "retrospective", "n": 735, "nField": "reported", "population": "patients with pilonidal sinus disease treated with crystallized phenol", "intervention": "hair removal using depilatory cream combined with crystallized phenol treatit", "comparator": "patients who did not undergo hair removal or had shorter hair removal duration", "primaryOutcome": "recurrence of pilonidal sinus disease after treatment", "result": "hair removal was associated with significantly less recurrence (OR 0.54) and longer hair removal duration further reduced recurrence odds", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "46.23 ± 33 (range, 11-240) months", "plainFinding": "Hair removal cream aided phenol treatment, not alone.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33915547/", "sourceText": "OBJECTIVE: The most important cause of posttreatment recurrence of pilonidal sinus disease (PSD) is the reentry of hair into the skin. The study aimed to investigate the effect of hair removal and its duration on the prevention of recurrence after crystallized phenol treatment. SUBJECT AND METHODS: Patients with PSD who were treated with crystallized phenol treatment were evaluated. 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. Of 1,016 patients, 735 were contacted by telephone or e-mail regarding the frequency of sacrococcygeal hair removal and recurrence. Demographic and sinus features and crystallized phenol application data of patients treated with crystallized phenol for PSD, as well as recurrences were retrospectively assessed. RESULTS: The mean follow-up time was 46.23 ± 33 (range, 11-240) months, with 139 (18.9%) patients experiencing recurrence. 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]). The OR of recurrence decreased by 0.8% every month as the hair removal time increased (OR: 0.992, 95% CI: 0.985-1.000, p = 0.049). The cutoff value for sensitivity was 0.636, specificity 0.466, and area under the curve 0.562 in hair removal procedures that lasted for over 30 months. CONCLUSION: Regular hair removal during, and at least 30 months after, crystallized phenol treatment reduced recurrences in patients with PSD.", "provenance": [ { "field": "n", "quote": "Of 1,016 patients, 735 were contacted by telephone or e-mail regarding the frequency of sacrococcygeal hair removal and recurrence." }, { "field": "population", "quote": "Patients with PSD who were treated with crystallized phenol treatment were evaluated." }, { "field": "intervention", "quote": "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." }, { "field": "comparator", "quote": "Patients who underwent hair removal experienced significantly less recurrence than those who did not" }, { "field": "primaryOutcome", "quote": "Demographic and sinus features and crystallized phenol application data of patients treated with crystallized phenol for PSD, as well as recurrences were retrospectively assessed." }, { "field": "result", "quote": "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])." }, { "field": "followUp", "quote": "The mean follow-up time was 46.23 ± 33 (range, 11-240) months" } ] }, { "id": "pmid:32964496", "pmid": "32964496", "doi": "10.1002/lsm.23318", "nctId": null, "pmcid": null, "title": "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)", "firstAuthor": "Esposito", "multipleAuthors": true, "journal": "Lasers Surg Med", "year": 2020, "design": "retrospective", "n": 87, "nField": "reported", "population": "children and teenagers (12-18 years old) with chronic pilonidal sinus disease undergoing endoscopic surgery", "intervention": "laser hair removal plus oxygen-enriched oil-based gel dressing before and after surgery", "comparator": "silver sulfadiazine spray dressing after surgery only", "primaryOutcome": "wound healing time, disease recurrence, and wound infection rate after endoscopic pilonidal sinus surgery", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Faster healing, fewer recurrences, with surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32964496/", "sourceText": "BACKGROUND AND OBJECTIVE: Pediatric endoscopic pilonidal sinus treatment (PEPSiT) has become the new standard of care for pilonidal sinus disease (PSD) in pediatric patients. This study aimed to compare our current wound treatment protocol (laser epilation (LE) and oxygen-enriched oil-based gel dressing) with our previous protocol (silver sulfadiazine spray) and demonstrate its efficacy as means to prevent PSD recurrence in children undergoing PEPSiT. STUDY DESIGN/MATERIALS AND METHODS: We retrospectively reviewed the data of 87 pediatric patients, 52 boys and 35 girls, with an average age of 17.1 years (range, 12-18) affected by chronic PSD, who underwent PEPSiT over a 24-month period (December 2017-December 2019). The patients were divided into two groups: G1 (n = 47) treated with pre- and postoperative LE and oxygen-enriched oil-based gel dressing; and G2 (n = 40) treated with only postoperative dressing using silver sulfadiazine spray. The two groups were compared regarding the operative outcome, wound-healing time, disease recurrence, wound infections, and other complications. Furthermore, efficacy, safety, and tolerability of LE were assessed in G1. RESULTS: No significant difference emerged between the two groups regarding the median operating time, postoperative pain score, hospital stay length, and time to full daily activities (P = 0.33). 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). All patients with wound infection were treated with oral antibiotics and, after the resolution of the acute episode, received LE with no further infections (Clavien II). Granuloma of the wound occurred in two G2 patients (5%), who were treated with topical silver nitrate (Clavien II). LE was well-tolerated and without complications in all G1 patients; a median number of 7 LE sessions (range, 4-10) at 4-6 weeks interval was required to achieve definitive hair removal. CONCLUSION: The results of this study confirmed that our standardized pre- and postoperative wound management, including LE and oxygen-enriched oil-based gel dressing, was extremely safe and effective in reducing PSD recurrence and wound infection rate in pediatric patients undergoing PEPSiT. LE should be routinely offered as adjunctive treatment to all patients who receive PEPSiT and is strongly advocated to be started before surgery and continued after wound healing. More importantly, LE showed to have a role as a preventive modality in patients with recurrent folliculitis or infections at the intergluteal crease. It was also associated with significant improvement and acceleration of wound-healing time. LE and oxygen-enriched oil-based gel dressings were clinically safe and well-tolerated in all patients, with no adverse skin reactions or injuries to both therapies. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.", "provenance": [ { "field": "n", "quote": "We retrospectively reviewed the data of 87 pediatric patients" }, { "field": "population", "quote": "pediatric patients, 52 boys and 35 girls, with an average age of 17.1 years (range, 12-18) affected by chronic PSD" }, { "field": "intervention", "quote": "G1 (n = 47) treated with pre- and postoperative LE and oxygen-enriched oil-based gel dressing" }, { "field": "comparator", "quote": "G2 (n = 40) treated with only postoperative dressing using silver sulfadiazine spray" }, { "field": "primaryOutcome", "quote": "compared regarding the operative outcome, wound-healing time, disease recurrence, wound infections, and other complications" }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:32671004", "pmid": "32671004", "doi": "10.3389/fped.2020.00345", "nctId": null, "pmcid": "PMC7326782", "title": "Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT) in Children With Pilonidal Sinus Disease: Tips and Tricks and New Structurated Protocol", "firstAuthor": "Esposito", "multipleAuthors": true, "journal": "Front Pediatr", "year": 2020, "design": "retrospective", "n": 127, "nField": "reported", "population": "children and teenagers who had surgery for pilonidal sinus disease", "intervention": "oxygen-enriched oil-based gel dressing applied after endoscopic pilonidal surgery and laser hair removal", "comparator": "silver sulfadiazine spray dressing after the same surgery", "primaryOutcome": "treatment success rate, recurrence, wound infection, healing time and patient satisfaction after surgery", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a retrospective, non-randomized comparison of a wound dressing used only after surgery, not a test of cream as a standalone treatment.", "directness": "indirect", "limitations": "retrospective design, no randomization, and the cream/gel was only an adjunct to surgery rather than a treatment for the cyst itself", "followUp": "", "plainFinding": "Better post-surgery healing with oil gel dressing", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32671004/", "sourceText": "Background: The advent of pediatric endoscopic pilonidal sinus treatment (PEPSiT) has dramatically changed the surgical management of pilonidal sinus disease (PSD) in children and adolescents. This study aimed to report the outcome of our new structurated protocol, including PEPSiT, laser epilation, and oxygen-enriched oil-based gel dressing, for treatment of PSD in pediatric patients and describe tips and tricks of the technique. Methods: We retrospectively reviewed the data of 127 pediatric patients, who underwent PEPSiT for PSD in our institutions over a 36-month period. All patients received laser epilation (LE) before and after surgery. Post-operative dressing was performed using silver sulfadiazine spray and in the last 18 months oxygen-enriched oil-based gel. We divided the patients in two groups according to the protocol adopted: G1 (laser + oxygen-enriched oil-based gel dressing) included 72 patients and G2 (laser + silver sulfadiazine spray dressing) included 55 patients. The two groups were compared regarding success rate, recurrence, wound infection rate, wound healing time, post-operative outcome, time to full daily activities and patient satisfaction. Results: No difference emerged between the two groups regarding the average operative time, the average post-operative pain score, the average analgesic requirement, the average hospitalization and the average time to full daily activities (p = 0.33). No intra- or post-operative complications including wound infection occurred in both groups. The patients required an average number of 7 LE sessions (range 4-10) to achieve complete hair removal. 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]. Conclusions: Based upon our experience, PEPSiT may be considered the standard of care for surgical treatment of PSD in children and adolescents. Our new structurated protocol consisting of pre-operative LE, PEPSiT, and post-operative wound management with oxygen-enriched oil-based gel dressing and LE, allowed to achieve an excellent outcome, with a success rate > 98%.", "provenance": [ { "field": "n", "quote": "We retrospectively reviewed the data of 127 pediatric patients, who underwent PEPSiT for PSD in our institutions over a 36-month period." }, { "field": "population", "quote": "127 pediatric patients, who underwent PEPSiT for PSD" }, { "field": "intervention", "quote": "G1 (laser + oxygen-enriched oil-based gel dressing) included 72 patients" }, { "field": "comparator", "quote": "G2 (laser + silver sulfadiazine spray dressing) included 55 patients" }, { "field": "primaryOutcome", "quote": "compared regarding success rate, recurrence, wound infection rate, wound healing time, post-operative outcome, time to full daily activities and patient satisfaction" }, { "field": "result", "quote": "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]." } ] }, { "id": "pmid:32530778", "pmid": "32530778", "doi": "10.12968/jowc.2020.29.6.321", "nctId": null, "pmcid": null, "title": "Traditional and advanced therapeutic modalities for wounds in the paediatric population: an evidence-based review", "firstAuthor": "McNamara", "multipleAuthors": true, "journal": "J Wound Care", "year": 2020, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "children with non-healing wounds from various causes, including pilonidal disease", "intervention": "various wound care treatments such as dressings, topical remedies, and skin substitutes", "comparator": "", "primaryOutcome": "", "result": "The abstract does not report any specific finding about cream treatment for pilonidal cyst or sinus", "resultDirection": "unclear", "quality": "low", "qualityWhy": "It is a general narrative review of paediatric wound care without a defined outcome or data on pilonidal cyst cream treatment.", "directness": "indirect", "limitations": "The abstract admits that high-tier evidence in paediatric wound populations is scarce and does not address pilonidal cyst/sinus cream treatment specifically.", "followUp": "", "plainFinding": "No specific finding reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32530778/", "sourceText": "OBJECTIVE: Children can have non-healing wounds due to a wide range of pathologies, including epidermolysis bullosa (EB), pilonidal disease and Stevens-Johnson syndrome, with some causes being iatrogenic, including extravasation injuries and medical device-related hospital-acquired pressure ulcers. Furthermore, paediatric wounds are vastly different from adult wounds and therefore require a different treatment approach. While there are numerous types of dressings, topical remedies, and matrices with high-tier evidence to support their use in adults, evidence is scarce in the neonatal and paediatric age groups. The purpose of this review is to discuss the basic principles in paediatric wound management, as well as to present new treatment findings published in the literature to date. The benefits and risks of using different types of debridement are discussed in this review. Various topical formulations are also described, including the need to use antibiotics judiciously. METHOD: Databases were searched for relevant sources including Pubmed, Embase, Web of Science and DynaMed. Search terms used included 'wound care', 'wound management', 'paediatrics', 'children', 'skin substitutes', and 'grafts'. Additionally, each treatment and disease entity was searched for relevant sources, including, for example: 'Apligraf', 'dermagraft', 'Manuka honey', 'antibiotic', 'timolol', and 'negative pressure wound therapy' (NPWT). RESULTS: Amniotic membrane living skin equivalent is a cellular matrix that has been reportedly successful in treating paediatrics wounds and is currently under investigation in randomised clinical trials. Helicoll is an acellular matrix, which shows promise in children with recessive dystrophic EB. NPWT may be used as a tool to accelerate wound closure in children; however, caution must be taken due to limited evidence to support its safety and efficacy in the paediatric patient population. Integra has been reported as a useful adjunctive treatment to NPWT as both may act synergistically. Hospitalised children and neonates frequently have pressure ulcers, which is why prevention in this type of wound is paramount. CONCLUSION: 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. We hope to shed light on existing evidence regarding the different therapeutic modalities, from debridement techniques and dressing types to tissue substitutes and topical remedies. There have been promising results in many studies to date, but RCTs involving larger sample sizes are necessary, in order to determine the specific role these innovative agents play in paediatric wounds and to identify true safety and efficacy.", "provenance": [ { "field": "population", "quote": "Children can have non-healing wounds due to a wide range of pathologies, including epidermolysis bullosa (EB), pilonidal disease and Stevens-Johnson syndrome" }, { "field": "intervention", "quote": "Various topical formulations are also described, including the need to use antibiotics judiciously." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:31775962", "pmid": "31775962", "doi": null, "nctId": null, "pmcid": null, "title": "Long-Term Outcomes of Crystallized Phenol Application after Punch Excision for the Treatment of Pilonidal Sinus Disease", "firstAuthor": "Demirel", "multipleAuthors": true, "journal": "Am Surg", "year": 2019, "design": "case-series", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease treated with a punch biopsy procedure", "intervention": "crystallized phenol applied into the sinus cavity after punch excision of the opening", "comparator": "no comparison group; outcomes tracked over time within the same patients", "primaryOutcome": "recurrence of the pilonidal sinus after treatment", "result": "About 12% of patients had recurrence early on and about 13% had recurrence at long-term follow-up (mean 23.7 months)", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "16 to 38 months (mean 23.7 months)", "plainFinding": "Low recurrence after phenol plus excision.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31775962/", "sourceText": "The aim of the study was to present the outcomes of topical crystallized phenol application in the treatment of pilonidal sinus disease. Under local anesthesia, 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. Three sessions of additional therapy were given one week apart without anesthesia. The technique was well tolerated, and early results were observed two months after the procedure. Recurrence was detected in five patients (11.9%), one of whom underwent two more sessions, resulting in recovery. 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%). Analysis of the data was unable to identify significant effects of the characteristics of the disease (primary or recurrent), gender of patients, and the number of opening holes (single or multiple) on early and late recurrence (P > 0.05). A close correlation can be drawn from the early- and long-term results after treatment (P < 0.0001). In this study, the use of the punch biopsy tool in the treatment of pilonidal sinus disease with crystallized phenol was described first. This minimally invasive method achieved excellent aesthetic outcomes, and it can successfully be applied without the need for surgical intervention, especially in patients who are at the initial stage and with small in size openings.", "provenance": [ { "field": "population", "quote": "the treatment of pilonidal sinus disease" }, { "field": "intervention", "quote": "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" }, { "field": "comparator", "quote": "it can successfully be applied without the need for surgical intervention" }, { "field": "primaryOutcome", "quote": "Recurrence was detected in five patients (11.9%)" }, { "field": "result", "quote": "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%)." }, { "field": "followUp", "quote": "16 to 38 months (mean 23.7 months)" } ] }, { "id": "pmid:31616217", "pmid": "31616217", "doi": "10.5114/ada.2018.77255", "nctId": null, "pmcid": "PMC6791160", "title": "Topical polyphenol treatment of sacrococcygeal pilonidal sinus disease: use of ultrasonography to evaluate response to treatment - clinical case series study", "firstAuthor": "Aksoy", "multipleAuthors": true, "journal": "Postepy Dermatol Alergol", "year": 2019, "design": "case-series", "n": 14, "nField": "reported", "population": "young adults aged 18-45 with sacrococcygeal pilonidal sinus disease", "intervention": "topical natural polyphenol cream applied for a median of 3 months", "comparator": "none (before-and-after comparison, no control group)", "primaryOutcome": "disease resolution assessed by physical exam and ultrasonography", "result": "most patients improved or were disease-free after treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a small, uncontrolled case series without a comparison group, so it can't rule out natural improvement or bias.", "directness": "direct", "limitations": "Retrospective, no control group, small sample size of 14 patients", "followUp": "18.3 months", "plainFinding": "Most patients healed without surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31616217/", "sourceText": "INTRODUCTION: Sacrococcygeal pilonidal sinus disease (SPSD) is a common disorder and encountered more frequently in hairy young males after puberty. AIM: To assess effectiveness of topical polyphenol treatment of SPSD by using physical examination and ultrasonography (USG). MATERIAL AND METHODS: Fourteen patients with SPSD diagnosis were treated by natural polyphenol products and were retrospectively included in this study. All of the patients were assessed by superficial ultrasonography before and after treatment. Demographic and clinical information of the patients was obtained from medical records. RESULTS: Patients were aged 18-45 years and the median disease duration was 2 years. The most common findings in physical examination were sinus openings and subcutaneous nodules and the most common ultrasonographic findings were abscess/cyst formation and presence of fistula at the pre-treatment visit. All of the patients applied topical polyphenols for a median period of 3 months. 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. Control physical examination and ultrasonographic assessment were completely normal in 11 (78.6%) patients. CONCLUSIONS: Topical polyphenol therapy is a promising alternative treatment for SPSD and its effectiveness can be objectively evaluated by ultrasonography. It is advised that topical polyphenols should be tried first in every young and active patient with SPSD. Majority of these patients can avoid demanding and expensive alternative treatment methods such as complex surgical procedures. This topical therapy method makes surgical SPSD a dermatologically treatable disease.", "provenance": [ { "field": "n", "quote": "Fourteen patients with SPSD diagnosis were treated by natural polyphenol products and were retrospectively included in this study." }, { "field": "population", "quote": "Patients were aged 18-45 years and the median disease duration was 2 years." }, { "field": "intervention", "quote": "All of the patients applied topical polyphenols for a median period of 3 months." }, { "field": "comparator", "quote": "Fourteen patients with SPSD diagnosis were treated by natural polyphenol products and were retrospectively included in this study." }, { "field": "primaryOutcome", "quote": "To assess effectiveness of topical polyphenol treatment of SPSD by using physical examination and ultrasonography (USG)." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:29923900", "pmid": "29923900", "doi": "10.1097/01.ASW.0000534702.34915.90", "nctId": null, "pmcid": null, "title": "Evaluating a Surfactant-Containing Polymeric Membrane Foam Wound Dressing with Glycerin in Patients with Chronic Pilonidal Sinus Disease", "firstAuthor": "Sibbald", "multipleAuthors": true, "journal": "Adv Skin Wound Care", "year": 2018, "design": "case-series", "n": 16, "nField": "reported", "population": "adults aged 18 to 49 with chronic, non-healing pilonidal sinus wounds lasting more than 4 weeks", "intervention": "a surfactant-containing polymeric membrane foam wound dressing with glycerin applied daily", "comparator": "no comparator group; single-arm observational study", "primaryOutcome": "wound closure after 12 weeks of treatment", "result": "At 12 weeks, 10 of 16 wounds (63%) had closed, 1 had shrunk, 2 had grown larger, and 3 patients dropped out", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "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.", "directness": "indirect", "limitations": "No control group, small sample size, and nearly a fifth of patients lost to follow-up.", "followUp": "12 weeks", "plainFinding": "Most wounds closed with dressing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29923900/", "sourceText": "GENERAL PURPOSE: To present an evaluation of a surfactant-containing polymeric membrane foam wound dressing for use on patients with chronic pilonidal sinus disease. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be able to:1. Recall risk factors for and pathophysiology of pilonidal sinus wounds.2. Summarize the evidence-based elements of wound assessment and treatment.3. Identify the study methodology and results. ABSTRACT: To evaluate the clinical use of a surfactant-containing polymeric wound dressing with glycerin in patients with chronic pilonidal sinus wounds.This case series was conducted in an outpatient dermatology and wound clinic. Sixteen patients aged between 18 and 49 years with chronic nonhealing pilonidal sinus wounds over 4 weeks in duration were recruited.Dressing changes were performed daily because of frequent contamination from bowel evacuation, sweating, or frictional forces in the perianal and intergluteal skin. Patients were seen at follow-up visits to the clinic at weeks 4, 8, and 12 from study initiation.Subjects were predominantly males (81% [n = 13]) with a mean age of 23 years. At study initiation, the mean wound duration was 3.2 months, and mean surface area was 3.3 cm (0.18-19.6 cm). The majority of wounds showed signs of superficial infection (63% [n = 10]) and deep infection (88% [n = 14]). 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. Mean pain score was 3.4 at first visit; most patients reported reduction in pain scores by weeks 4 and 12. Participants reported improved mobility and ability to self-apply dressing. No adverse reactions were observed.Use of a surfactant-containing polymeric membrane foam wound dressing with glycerin may have facilitated wound closure in 10 of 13 patients who completed the 12-week study.", "provenance": [ { "field": "n", "quote": "Sixteen patients aged between 18 and 49 years with chronic nonhealing pilonidal sinus wounds over 4 weeks in duration were recruited." }, { "field": "population", "quote": "patients aged between 18 and 49 years with chronic nonhealing pilonidal sinus wounds over 4 weeks in duration" }, { "field": "intervention", "quote": "a surfactant-containing polymeric wound dressing with glycerin" }, { "field": "comparator", "quote": "This case series was conducted in an outpatient dermatology and wound clinic." }, { "field": "primaryOutcome", "quote": "To evaluate the clinical use of a surfactant-containing polymeric wound dressing with glycerin in patients with chronic pilonidal sinus wounds." }, { "field": "result", "quote": "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." }, { "field": "followUp", "quote": "Patients were seen at follow-up visits to the clinic at weeks 4, 8, and 12 from study initiation." } ] }, { "id": "pmid:29185064", "pmid": "29185064", "doi": "10.1007/s10151-017-1722-9", "nctId": null, "pmcid": null, "title": "The effect of hair removal after surgery for sacrococcygeal pilonidal sinus disease: a systematic review of the literature", "firstAuthor": "Pronk", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2018, "design": "systematic-review", "n": 963, "nField": "reported", "population": "adults who had surgery for pilonidal sinus disease near the tailbone", "intervention": "hair removal with razor shaving or cream depilation after surgery", "comparator": "no hair removal after surgery", "primaryOutcome": "rate of cyst/sinus recurrence after surgery", "result": "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%)", "resultDirection": "mixed", "quality": "low", "qualityWhy": "the included studies were mostly small retrospective cohorts with limited methodological quality, so the comparison is not very reliable.", "directness": "indirect", "limitations": "small sample size and limited methodological quality of the included studies", "followUp": "37.0 (standard error of the mean: 35.0) months", "plainFinding": "Cream removal didn't lower recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29185064/", "sourceText": "BACKGROUND: It has been suggested that removal of body hair in the sacrococcygeal area prevents recurrence after surgery for sacrococcygeal pilonidal sinus disease (SPSD). The aim of this study was to review the literature regarding the effect of hair depilation on the recurrence rate in patients surgically treated for SPSD. METHODS: A systematic search was performed in PubMed, EMBASE, and The Cochrane Library by using synonyms for SPSD. Title, abstract, and full text were screened by two independent reviewers. Data were systematically collected from all included studies by using a standardized data extraction form. RESULTS: The search and selection yielded 14 studies, involving 963 patients. The study design of the included studies was: retrospective cohort (n = 7), prospective cohort (n = 3), randomized controlled trial (n = 2), and case-control (n = 2).The mean length of follow-up was 37.0 (standard error of the mean: 35.0) months. The recurrence rate was 9.3% (34 out of 366 patients) in patients who had laser hair removal, 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. CONCLUSIONS: This systematic review showed a lower recurrence rate after laser hair removal compared to no hair removal and razor/cream depilation. Due to the small sample size and limited methodological quality of the included studies, a high-quality randomized controlled trial is required.", "provenance": [ { "field": "n", "quote": "involving 963 patients" }, { "field": "population", "quote": "patients surgically treated for SPSD" }, { "field": "intervention", "quote": "razor shaving/cream depilation" }, { "field": "comparator", "quote": "no hair removal after surgery for SPSD" }, { "field": "primaryOutcome", "quote": "the effect of hair depilation on the recurrence rate in patients surgically treated for SPSD" }, { "field": "result", "quote": "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" } ] }, { "id": "pmid:28549686", "pmid": "28549686", "doi": "10.1016/j.jpedsurg.2017.05.012", "nctId": null, "pmcid": null, "title": "Pilonidal sinus disease surgery in children: the first study to compare crystallized phenol application to primary excision and closure", "firstAuthor": "Ates", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2018, "design": "retrospective", "n": 117, "nField": "reported", "population": "children and teenagers with pilonidal sinus disease", "intervention": "crystallized phenol application", "comparator": "surgical excision with primary closure", "primaryOutcome": "recurrence and complication rates, hospital stay", "result": "phenol group had shorter hospital stay and seemed to have lower recurrence and complication rates, but follow-up time differed greatly between groups", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study with very different follow-up times between groups, so the comparison is not reliable.", "directness": "direct", "limitations": "Retrospective data; follow-up was much shorter for the phenol group (8.1 months) than the surgery group (44.6 months)", "followUp": "8.1 (1-19) months for phenol group; 44.6 (8-82) months for excision and closure group", "plainFinding": "Phenol may work, shorter follow-up though.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28549686/", "sourceText": "INTRODUCTION: Pilonidal sinus (PS) is an infectious and inflammatory disease of sacrococcygeal region. Current methods include; surgical excision with/without suturing the defect, rhomboid excision and flap and chemical substance application. In this study, crystallized phenol application was compared to excision and primary closure. PATIENTS AND METHODS: This retrospective study included pediatric patients with PS who were treated with excision and primer closure technique and phenol application. The patients' medical data were analyzed retrospectively. RESULTS: This study included 117 patients with PS. There were 52 girls (44%) and 65 boys (56%). Mean age of children was 15.6 (12-20) years. Excision and primary closure were applied to 77 patients (66%) and phenol was applied to 40 patients (34%). The children in phenol group were discharged on the operation day; mean hospitalization time in the excision and primary closure group was 2.7 (1-14) days. Mean follow up was 44.6 (8-82) months for primary excision and closure group and 8.1 (1-19) months for phenol group. CONCLUSION: Although many surgical and non-surgical treatment modalities have been described for PS, the optimal one remains unknown. Limited with the retrospective nature of the data, crystallized phenol application seems a feasible minimal invasive alternative to primary closure of PS with lower recurrence and complication rates in children. TREATMENT STUDY: Level III.", "provenance": [ { "field": "n", "quote": "This study included 117 patients with PS." }, { "field": "population", "quote": "This retrospective study included pediatric patients with PS" }, { "field": "intervention", "quote": "crystallized phenol application" }, { "field": "comparator", "quote": "excision and primer closure technique" }, { "field": "primaryOutcome", "quote": "crystallized phenol application seems a feasible minimal invasive alternative to primary closure of PS with lower recurrence and complication rates in children" }, { "field": "result", "quote": "crystallized phenol application seems a feasible minimal invasive alternative to primary closure of PS with lower recurrence and complication rates in children" }, { "field": "followUp", "quote": "Mean follow up was 44.6 (8-82) months for primary excision and closure group and 8.1 (1-19) months for phenol group." } ] }, { "id": "pmid:28352930", "pmid": "28352930", "doi": "10.15570/actaapa.2017.4", "nctId": null, "pmcid": null, "title": "Pilonidal sinus disease can be treated with crystallized phenol using a simple three-step technique", "firstAuthor": "Yuksel", "multipleAuthors": false, "journal": "Acta Dermatovenerol Alp Pannonica Adriat", "year": 2017, "design": "case-series", "n": 50, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "crystallized phenol applied into the sinus opening using a three-step technique", "comparator": "none (no comparison group, single-arm treatment)", "primaryOutcome": "closure of pilonidal sinus openings without leakage (healing)", "result": "88% of patients were cured after a single application", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, uncontrolled case series without a comparison group, so it can't show whether phenol works better than other treatments.", "directness": "indirect", "limitations": "No control group, small sample, and treatment failures occurred especially after prior surgery or wound infection.", "followUp": "", "plainFinding": "Mostly healed sinus with phenol.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28352930/", "sourceText": "INTRODUCTION: Pilonidal sinus disease can be treated with various surgical techniques. However, invasive surgical techniques harbor the risk of wound infection and require a long postoperative wound healing period. The treatment of pilonidal sinus disease with crystallized phenol is minimally invasive with a short postoperative recovery period. This article explains how to treat pilonidal sinus disease with crystallized phenol using a quick and easy three-step technique. METHODS: Between August 2014 and January 2016, 43 male and 7 female patients with pilonidal sinus disease were treated with crystallized phenol. Hair was gently removed from the sinus openings with a mosquito clamp. Afterwards, the pilonidal sinus openings were gently filled with crystallized phenol. RESULTS: The closure of pilonidal sinus openings without any leakage after a single application of crystallized phenol was accepted as healing. The treatment failed in two of the female patients, who had had prior pilonidal sinus surgery, and in four of the male patients, who had a recurrence after wound site infection. The overall cure rate was 88%. CONCLUSIONS: Treatment of pilonidal sinus disease with crystallized phenol using the three-step technique is simple, fast, and comfortable. Therefore, crystallized phenol should be preferentially considered in the treatment of pilonidal sinus disease.", "provenance": [ { "field": "n", "quote": "43 male and 7 female patients with pilonidal sinus disease were treated with crystallized phenol" }, { "field": "population", "quote": "patients with pilonidal sinus disease" }, { "field": "intervention", "quote": "the pilonidal sinus openings were gently filled with crystallized phenol" }, { "field": "comparator", "quote": "43 male and 7 female patients with pilonidal sinus disease were treated with crystallized phenol" }, { "field": "primaryOutcome", "quote": "The closure of pilonidal sinus openings without any leakage after a single application of crystallized phenol was accepted as healing." }, { "field": "result", "quote": "The overall cure rate was 88%." } ] }, { "id": "pmid:26883556", "pmid": "26883556", "doi": "10.1016/j.asjsur.2015.12.007", "nctId": null, "pmcid": null, "title": "Crystallized phenol application and modified Limberg flap procedure in treatment of pilonidal sinus disease: A comparative retrospective study", "firstAuthor": "Bayhan", "multipleAuthors": true, "journal": "Asian J Surg", "year": 2016, "design": "retrospective", "n": 81, "nField": "reported", "population": "patients diagnosed with pilonidal sinus disease", "intervention": "crystallized phenol application (a chemical treatment applied to the sinus)", "comparator": "modified Limberg flap surgery", "primaryOutcome": "hospital stay, wound complications, and recurrence rate", "result": "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%", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, no randomization, relatively small groups (37 vs 44 patients), and outcome depended on multiple treatment sessions.", "followUp": "", "plainFinding": "Similar cure rates, fewer complications with phenol.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26883556/", "sourceText": "BACKGROUND/OBJECTIVE: Pilonidal sinus treatment includes various surgical and minimally invasive procedures, but there is still no standard treatment. Flap reconstructions and minimally invasive treatment options such as crystallized phenol application have recently been in the center of interest. The aim of this study is to compare crystallized phenol application as a minimally invasive treatment with modified Limberg flap reconstruction from many aspects. METHODS: 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 in terms of age, sex, length of stay in hospital postoperatively, wound complications, and the cause and rate of recurrence. RESULTS: 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). Although the recurrence rate was found to be higher in the patient group treated once with crystallized phenol application, the success rate following multiple applications of crystallized phenol was found to be 94.5%. Higher body mass index (> 24.9 kg/m(2)) and surgical site infection were strongly correlated with recurrence rate (p < 0.001). DISCUSSION: Crystallized phenol application is a good alternative to the modified Limberg flap procedure and other surgical procedures, because it has several advantages such as being a minimally invasive procedure performed under local anesthesia with higher success rate after multiple applications, decreased length of stay in hospital, and minimal scar tissue formation.", "provenance": [ { "field": "population", "quote": "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" }, { "field": "intervention", "quote": "crystallized phenol application" }, { "field": "comparator", "quote": "modified Limberg flap reconstruction" }, { "field": "primaryOutcome", "quote": "length of stay in hospital postoperatively, wound complications, and the cause and rate of recurrence" }, { "field": "result", "quote": "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)." }, { "field": "result", "quote": "the success rate following multiple applications of crystallized phenol was found to be 94.5%" }, { "field": "n", "quote": "Thirty-seven patients diagnosed with pilonidal sinus and treated with modified Limberg flap reconstruction, and 44 patients treated with crystallized phenol application" } ] }, { "id": "pmid:26054992", "pmid": "26054992", "doi": null, "nctId": null, "pmcid": null, "title": "Topical Agents and Dressings for Pilonidal Sinus Wound Healing by Secondary Intention: A Scoping Review", "firstAuthor": "Woo", "multipleAuthors": true, "journal": "Surg Technol Int", "year": 2015, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus wounds healing after surgery", "intervention": "topical agents or dressings (like hydrogel, silver, honey, zinc, foam, negative pressure therapy, platelet rich plasma, plant extracts)", "comparator": "", "primaryOutcome": "wound healing by secondary intention", "result": "some evidence these topical treatments may help healing, reduce bacteria, or ease pain, but evidence is weak", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a scoping review of studies with acknowledged methodological limitations and biases, so the findings are not reliable evidence.", "directness": "indirect", "limitations": "abstract states evidence remains insufficient due to methodological limitations and biases of the included studies", "followUp": "", "plainFinding": "Weak, inconclusive evidence creams help healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26054992/", "sourceText": "Pilonidal disease (PD) is a chronic and debilitating condition. The overall aim of the scoping review is to map and summarize a wide range of evidence to examine which topical agent or dressing is effective in promoting pilonidal wound healing by secondary intention. Review of this cumulative body of evidence will inform care and guide dressing selection for PD related wounds and delineate future research priorities based on identified knowledge gaps and clinical practice issues. Overall, 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. Topical treatment using polyhexamethylene biguanide and silver may be beneficial in reducing bacterial burden. Finally, silver, honey, and hydrocolloid dressings may help alleviate wound related pain. However, evidence remains insufficient in light of methodological limitations and biases of the studies.", "provenance": [ { "field": "population", "quote": "which topical agent or dressing is effective in promoting pilonidal wound healing by secondary intention" }, { "field": "intervention", "quote": "hydrogel, silver, honey, zinc, selected foam materials, negative pressure wound therapy, platelet rich plasma, and plant extracts" }, { "field": "primaryOutcome", "quote": "promoting pilonidal wound healing by secondary intention" }, { "field": "result", "quote": "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" }, { "field": "limitations", "quote": "evidence remains insufficient in light of methodological limitations and biases of the studies" } ] }, { "id": "pmid:23595590", "pmid": "23595590", "doi": "10.1007/s12011-013-9658-z", "nctId": null, "pmcid": null, "title": "Zinc, copper, and selenium tissue levels and their relation to subcutaneous abscess, minor surgery, and wound healing in humans", "firstAuthor": "Mirastschijski", "multipleAuthors": true, "journal": "Biol Trace Elem Res", "year": 2013, "design": "rct", "n": 42, "nField": "reported", "population": "adults with pilonidal sinus disease having surgery", "intervention": "topical zinc oxide cream applied to the wound", "comparator": "placebo cream", "primaryOutcome": "wound healing and zinc, copper and selenium levels in the wound tissue", "result": "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", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "small study of 42 patients looking mainly at tissue chemical levels rather than a clear clinical healing outcome", "directness": "direct", "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", "followUp": "", "plainFinding": "Zinc cream no better than placebo", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23595590/", "sourceText": "Trace element involvement in wounds left to heal by secondary intention needs clarification. We have previously reported faster healing of wounds following acute surgery compared with elective excision of pilonidal sinus disease. The effect of topical zinc on the closure of the excisional wounds was mediocre compared with placebo. In contrast, parenteral zinc, copper, and selenium combined appear effective for wound healing in humans. We have investigated zinc, copper, and selenium with respect to (a) impact of acute versus chronic pilonidal sinus and (b) regional concentrations within granulating wounds treated topically with placebo or zinc in 42 (33 males) pilonidal disease patients. Baseline serum and skin concentrations of copper correlated (r S = 0.351, p = 0.033, n = 37), but not of zinc or selenium. Patients with abscesses had elevated serum C-reactive protein (CRP) and copper levels (+29 %; p < 0.001) compared with the elective patients consistent with the strong correlation between serum copper and CRP (r S = 0.715, p < 0.0005, n = 41). Seven days after elective surgery, serum CRP and copper levels were elevated (p = 0.010) versus preoperative values. The copper concentration in wound edges was higher than in periwound skin (p < 0.0005) and wound base (p = 0.010). Selenium levels were increased in wound edge compared to wound base (p = 0.003). Topical zinc oxide treatment doubled (p < 0.050) zinc concentrations in the three tissue localizations without concomitant significant changes of copper or selenium levels. In conclusion, copper and selenium are mobilized to injured sites possibly to enhance host defense and early wound healing mechanisms that are complementary to the necessity of zinc for matrix metalloproteinase activity.", "provenance": [ { "field": "n", "quote": "42 (33 males) pilonidal disease patients" }, { "field": "population", "quote": "pilonidal disease patients" }, { "field": "intervention", "quote": "topically with placebo or zinc" }, { "field": "comparator", "quote": "treated topically with placebo or zinc" }, { "field": "primaryOutcome", "quote": "regional concentrations within granulating wounds treated topically with placebo or zinc" }, { "field": "result", "quote": "The effect of topical zinc on the closure of the excisional wounds was mediocre compared with placebo." }, { "field": "result", "quote": "Topical zinc oxide treatment doubled (p < 0.050) zinc concentrations in the three tissue localizations without concomitant significant changes of copper or selenium levels." } ] }, { "id": "pmid:23294066", "pmid": "23294066", "doi": "10.9738/CC130.1", "nctId": null, "pmcid": "PMC3727265", "title": "Minimally invasive treatment of pilonidal disease: crystallized phenol and laser depilation", "firstAuthor": "Girgin", "multipleAuthors": true, "journal": "Int Surg", "year": 2012, "design": "case-series", "n": 42, "nField": "reported", "population": "patients with chronic or recurrent pilonidal disease", "intervention": "crystallized phenol treatment combined with alexandrite laser hair removal", "comparator": "none (single group, no control treatment)", "primaryOutcome": "complete healing and recurrence of pilonidal disease after treatment", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small retrospective case series with no comparison group, so it can't show whether the treatment worked better than other options.", "directness": "indirect", "limitations": "Retrospective design, no control group, small sample size, some patients needed up to 8 repeat treatments.", "followUp": "mean 24 months (range, 6-30 months)", "plainFinding": "No recurrence after phenol plus laser", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23294066/", "sourceText": "Pilonidal disease has been treated surgically and by various other methods for many years. The most important problem associated with such treatment is recurrence, but cosmetic outcome is another important issue that cannot be ignored. Today, crystallized phenol is recognized as a treatment option associated with good medical and cosmetic outcomes. We hypothesized that the addition of laser depilation to crystallized phenol treatment of pilonidal disease might increase the rate of success, and this study aimed to determine if the hypothesis was true. Patients who were treated with crystallized phenol and 755-nm alexandrite laser depilation were retrospectively analyzed. In total, 42 (31 male and 11 female) patients were treated with crystallized phenol and alexandrite laser depilation and were followed up between January 2009 and January 2012. In all, 38 patients (90.5%) had chronic disease and 4 (9.5%) had recurrent disease. Among the patients, 26 (61.9%) recovered following 1 crystallized phenol treatment, and the remaining patients had complete remission following repeated treatment. Some patients needed multiple treatments, even up to 8 times. None of the patients had a recurrence during a mean 24 months (range, 6-30 months) of follow-up. Whatever method of treatment is used for pilonidal disease, hair cleaning positively affects treatment outcome. The present results support the hypothesis that the addition of laser depilation (which provides more permanent and effective depilation than other methods) to crystallized phenol treatment (a non-radical, minimally invasive method associated with very good cosmetic results) can increase the effectiveness of the treatment and also reduce the recurrence rate of the disease.", "provenance": [ { "field": "n", "quote": "In total, 42 (31 male and 11 female) patients were treated with crystallized phenol and alexandrite laser depilation" }, { "field": "population", "quote": "38 patients (90.5%) had chronic disease and 4 (9.5%) had recurrent disease" }, { "field": "intervention", "quote": "Patients who were treated with crystallized phenol and 755-nm alexandrite laser depilation were retrospectively analyzed." }, { "field": "comparator", "quote": "Patients who were treated with crystallized phenol and 755-nm alexandrite laser depilation were retrospectively analyzed." }, { "field": "primaryOutcome", "quote": "None of the patients had a recurrence during a mean 24 months (range, 6-30 months) of follow-up." }, { "field": "result", "quote": "Among the patients, 26 (61.9%) recovered following 1 crystallized phenol treatment, and the remaining patients had complete remission following repeated treatment." } ] }, { "id": "pmid:22240847", "pmid": "22240847", "doi": "10.12968/jowc.2011.20.11.528", "nctId": null, "pmcid": null, "title": "Manuka honey as an effective treatment for chronic pilonidal sinus wounds", "firstAuthor": "Thomas", "multipleAuthors": true, "journal": "J Wound Care", "year": 2011, "design": "retrospective", "n": 17, "nField": "reported", "population": "patients with chronic or recurrent pilonidal sinus disease after surgery", "intervention": "manuka honey dressing applied to the wound", "comparator": "no comparison group", "primaryOutcome": "complete wound healing and time to heal", "result": "15 of 17 patients healed completely, average 65 days; 2 had recurrence", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "small retrospective case series with no comparison group, so it cannot show honey worked better than standard care alone.", "directness": "direct", "limitations": "Retrospective design, no control group, small sample, one patient stopped due to adverse event.", "followUp": "", "plainFinding": "Most wounds healed with honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/22240847/", "sourceText": "OBJECTIVE: A retrospective study to investigate the effectiveness of topical manuka honey in the treatment of chronic or recurrent pilonidal sinus disease (PSD), assessing the ability of this simple dressing technique to achieve complete wound healing, the time taken to achieve healing and the recurrence rate. METHOD: All patients who received manuka honey dressing therapy following surgical intervention for chronic or recurrent PSD were identified over a 4-year period. In a retrospective review of case notes, data were collected on patient sex, age, nature of surgical procedures performed, time to achieve complete wound healing, and recurrences after completion of honey therapy. RESULTS: Seventeen patients were eligible for inclusion in the study. Mean time to commence honey therapy post-surgery was 93 days (5-517 days; median 33 days); 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. CONCLUSION: Manuka honey dressing therapy provides an effective topical treatment for chronic/recurrent PSD. Further research is necessary to determine the optimum dressing protocol. DECLARATION OF INTEREST: The authors have no conflicts of interest to declare. There were no external sources of funding for this study.", "provenance": [ { "field": "n", "quote": "Seventeen patients were eligible for inclusion in the study." }, { "field": "population", "quote": "patients who received manuka honey dressing therapy following surgical intervention for chronic or recurrent PSD" }, { "field": "intervention", "quote": "topical manuka honey in the treatment of chronic or recurrent pilonidal sinus disease" }, { "field": "comparator", "quote": "A retrospective study to investigate the effectiveness of topical manuka honey" }, { "field": "primaryOutcome", "quote": "assessing the ability of this simple dressing technique to achieve complete wound healing, the time taken to achieve healing and the recurrence rate" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:19438999", "pmid": "19438999", "doi": "10.1111/j.1600-0781.2009.00428.x", "nctId": null, "pmcid": null, "title": "Methyl aminolaevulinate photodynamic therapy for the treatment of hidradenitis suppurativa and pilonidal cysts", "firstAuthor": "Saraceno", "multipleAuthors": true, "journal": "Photodermatol Photoimmunol Photomed", "year": 2009, "design": "case-series", "n": 1, "nField": "reported", "population": "29-year-old man with hidradenitis suppurativa and pilonidal cysts since age 21", "intervention": "photodynamic therapy using topical methyl aminolaevulinate (MAL) cream applied with occlusive dressing and red light", "comparator": "previous treatments: antibiotics, corticosteroids and retinoids", "primaryOutcome": "clinical improvement of skin lesions and symptoms", "result": "achieved almost complete clinical remission (80%) of skin lesions and complete resolution of itching and discomfort", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report with no control group, so it cannot show whether the cream actually caused the improvement.", "directness": "indirect", "limitations": "Only one patient was treated, there was no comparison group, and the therapy required many costly sessions.", "followUp": "6-month follow-up", "plainFinding": "Mostly cleared skin lesions, one patient.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/19438999/", "sourceText": "Hidradenitis suppurativa (HS) and pilonidal cysts are chronic, inflammatory skin conditions involving apocrine gland-bearing skin. Treatment is limited and unsatisfactory. Photodynamic therapy (PDT) has been reported to be safe and effective in the treatment of several off-label skin conditions. We report the case of a 29-year-old man affected by HS and pilonidal cysts since the age of 21. In the past, the patient was treated with antibiotics, corticosteroids and retinoids, without significant clinical improvement. Treatment with methyl aminolaevulinate (MAL)-PDT was started. 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. Therapy was repeated every 15 days for a total of nine applications. The patient completed a 6-month follow-up and achieved an almost complete clinical remission of the skin lesions (80%) and complete resolution of the itching and discomfort. This is the first case of HS associated with pilonidal cysts treated with MAL-PDT. MAL-PDT was effective and well tolerated in our patient. The costs of this therapy represent an important limitation, taking into account the high number of sessions that were performed compared with non-melanoma skin cancers.", "provenance": [ { "field": "n", "quote": "the case of a 29-year-old man" }, { "field": "population", "quote": "a 29-year-old man affected by HS and pilonidal cysts since the age of 21" }, { "field": "intervention", "quote": "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." }, { "field": "comparator", "quote": "the patient was treated with antibiotics, corticosteroids and retinoids, without significant clinical improvement" }, { "field": "primaryOutcome", "quote": "achieved an almost complete clinical remission of the skin lesions (80%) and complete resolution of the itching and discomfort" }, { "field": "result", "quote": "achieved an almost complete clinical remission of the skin lesions (80%) and complete resolution of the itching and discomfort" }, { "field": "followUp", "quote": "The patient completed a 6-month follow-up" } ] }, { "id": "pmid:17014663", "pmid": "17014663", "doi": "10.1111/j.1743-6109.2006.00159.x", "nctId": null, "pmcid": null, "title": "A randomized, double-blind, placebo-controlled multicenter trial evaluating topical zinc oxide for acute open wounds following pilonidal disease excision", "firstAuthor": "Agren", "multipleAuthors": true, "journal": "Wound Repair Regen", "year": 2006, "design": "rct", "n": 64, "nField": "reported", "population": "adults after surgical removal of pilonidal cyst/sinus, with open wounds left to heal", "intervention": "topical zinc oxide cream applied to the open wound", "comparator": "placebo mesh dressing", "primaryOutcome": "time to complete wound healing", "result": "no significant difference in healing time, though zinc reduced bacterial infection and antibiotic use", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "it was a well-designed randomized, blinded trial but fairly small, so it may miss true differences in healing time.", "directness": "direct", "limitations": "authors state larger trials are needed to show definitive effects on healing and infection", "followUp": "", "plainFinding": "No difference in healing time.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/17014663/", "sourceText": "The purpose of this randomized, double-blind, placebo-controlled multicenter trial was to compare topical zinc oxide with placebo mesh on secondary healing pilonidal wounds. Sixty-four (53 men) consecutive patients, aged 17-60 years, were centrally randomized to either treatment with 3% zinc oxide (n = 33) or placebo (n = 31) by concealed allocation. Patients were followed with strict recording of beneficial and harmful effects including masked assessment of time to complete wound closure. Analysis was carried out on an intention-to-treat basis. 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). Topical zinc oxide increased (p < 0.001) wound fluid zinc levels to 1,540 (1,035-2,265) microM and decreased (p < 0.05) the occurrence of Staphylococcus aureus in wounds. Fewer zinc oxide (n = 3) than placebo-treated patients (n = 12) were prescribed postoperative antibiotics (p = 0.005). Serum-zinc levels increased (p < 0.001) postoperatively in both groups but did not differ significantly between the two groups on day 7. Zinc oxide was not associated with increased pain by the visual analog scale, cellular abnormalities by histopathological examination of wound biopsies, or other harmful effects. Larger clinical trials will be required to show definitive effects of topical zinc oxide on wound healing and infection.", "provenance": [ { "field": "n", "quote": "Sixty-four (53 men) consecutive patients" }, { "field": "population", "quote": "secondary healing pilonidal wounds" }, { "field": "intervention", "quote": "topical zinc oxide with placebo mesh" }, { "field": "comparator", "quote": "placebo mesh" }, { "field": "primaryOutcome", "quote": "masked assessment of time to complete wound closure" }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:12616370", "pmid": "12616370", "doi": "10.1007/s005950300022", "nctId": null, "pmcid": null, "title": "Effectiveness of collagenase in the treatment of sacrococcygeal pilonidal sinus disease", "firstAuthor": "Aldemir", "multipleAuthors": true, "journal": "Surg Today", "year": 2003, "design": "rct", "n": 40, "nField": "reported", "population": "patients with pilonidal sinus disease at the tailbone", "intervention": "excision and marsupialization with collagenase dressing", "comparator": "excision and marsupialization without collagenase dressing", "primaryOutcome": "wound healing speed and size", "result": "faster healing and smaller wound with collagenase dressing", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Small trial of only 40 patients, so the results may not be reliable.", "directness": "indirect", "limitations": "Small sample size; after surgical excision rather than cream alone; no mention of blinding.", "followUp": "", "plainFinding": "Faster wound healing after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/12616370/", "sourceText": "PURPOSE: Sacrococcygeal pilonidal sinus disease (SPSD) is a disease affecting young patients, which results in a long-term loss of productive power, and also tends to have high rates of morbidity since it has no ideal treatment. The main purpose of this study was to investigate the effectiveness of topical collagenase in the treatment of SPSD. METHODS: In the present study, 40 patients admitted to our department were separated into two groups. Excision and marsupialization with dressing by bacterial collagenase was performed in the first group, while the treatment was excision and marsupialization without dressing by bacterial collagenase in the second group. RESULTS: We determined that the healing in terms of the width and depth of the wound in the first week and in depth of wound in the second week was better in group 1 than in group 2 ( P = 0.040, P = 0.020, P = 0.048, respectively). 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). The recurrence rate in the intergluteal area, which heals by granulation and has no hair follicles, tends to decrease when a partial closure is obtained. CONCLUSION: We therefore recommend an excision, marsupialization, and dressing with bacterial collagenase, in cases with noncomplicated SPSD.", "provenance": [ { "field": "n", "quote": "40 patients admitted to our department were separated into two groups" }, { "field": "population", "quote": "Sacrococcygeal pilonidal sinus disease (SPSD) is a disease affecting young patients" }, { "field": "intervention", "quote": "Excision and marsupialization with dressing by bacterial collagenase was performed in the first group" }, { "field": "comparator", "quote": "the treatment was excision and marsupialization without dressing by bacterial collagenase in the second group" }, { "field": "primaryOutcome", "quote": "healing in terms of the width and depth of the wound in the first week and in depth of wound in the second week" }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:12490213", "pmid": "12490213", "doi": "10.1016/s0367-326x(02)00229-0", "nctId": null, "pmcid": null, "title": "Efficacy of Rhizophora mangle aqueous bark extract in the healing of open surgical wounds", "firstAuthor": "Fernandez", "multipleAuthors": true, "journal": "Fitoterapia", "year": 2002, "design": "rct", "n": 37, "nField": "reported", "population": "patients with open wounds after surgery for pilonidal cyst or pilonidal fistula", "intervention": "topical Rhizophora mangle aqueous bark extract applied once or twice daily", "comparator": "mercurochrome applied twice daily", "primaryOutcome": "reduction in wound area over 6 weeks after surgery", "result": "wounds treated with the bark extract shrank more than those treated with mercurochrome", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Small trial of only 37 people measuring wound size rather than patient-centered healing or recurrence outcomes.", "directness": "indirect", "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.", "followUp": "6 weeks", "plainFinding": "Faster wound shrinkage than mercurochrome", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/12490213/", "sourceText": "Thirty-seven patients with open wounds from surgical intervention of pilonidal cyst (14; 37.8%) or pilonidal fistula (23; 62.2%) were enrolled on a voluntary basis in a comparative blinded clinical trial and randomly assigned to a topical treatment with a Rhizophora mangle aqueous bark extract once a day or twice a day or mercurocrome twice a day. 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 and the tolerability by recording adverse effects. The initial size of the wounds was taken in consideration as covariable in the Generalized Lineal Model used. A thin dark red colored film covering the wound was observed in all the cases treated with the extract. 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. No differences between the two regimes of application of the extract of R. mangle were observed. No subject showed any sign of adverse effects and no secondary infections were observed.", "provenance": [ { "field": "n", "quote": "Thirty-seven patients with open wounds from surgical intervention of pilonidal cyst (14; 37.8%) or pilonidal fistula (23; 62.2%) were enrolled" }, { "field": "population", "quote": "patients with open wounds from surgical intervention of pilonidal cyst (14; 37.8%) or pilonidal fistula (23; 62.2%)" }, { "field": "intervention", "quote": "randomly assigned to a topical treatment with a Rhizophora mangle aqueous bark extract once a day or twice a day" }, { "field": "comparator", "quote": "or mercurocrome twice a day" }, { "field": "primaryOutcome", "quote": "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" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:11136304", "pmid": "11136304", "doi": "10.1046/j.1365-2168.2001.01631.x", "nctId": null, "pmcid": null, "title": "Systematic review of antimicrobial agents used for chronic wounds", "firstAuthor": "O'Meara", "multipleAuthors": true, "journal": "Br J Surg", "year": 2001, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people with chronic wounds (leg ulcers, diabetic foot ulcers, pilonidal sinuses)", "intervention": "antimicrobial agents, including systemic antibiotics and topical preparations", "comparator": "", "primaryOutcome": "wound healing", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a narrative (not statistical) review of small, methodologically weak trials, so the pilonidal-specific finding is only a tentative observation.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "No real evidence on creams for pilonidal sinus", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/11136304/", "sourceText": "BACKGROUND: This paper is one of a series of eight systematic reviews that aim to identify effective interventions for chronic wounds. Here, antimicrobial agents are evaluated. METHODS: Electronic databases and other relevant sources were accessed to identify published and unpublished material. Studies were eligible for inclusion if they used concurrent controls, recruited participants with chronic wounds, evaluated an intervention designed to prevent or treat chronic wounds, and incorporated an objective assessment of wound healing. All included studies were assessed against a comprehensive checklist for methodological quality. A narrative overview was conducted. RESULTS: Thirty trials were included, 25 of randomized design. Small sample size and other methodological problems meant that findings were often difficult to interpret. 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. Several topical preparations may be helpful, including dimethyl sulphoxide, silver sulphadiazine, benzoyl peroxide, oxyquinoline and gentamicin. CONCLUSION: Most of this research requires replication in larger, well designed studies to establish both clinical and cost effectiveness.", "provenance": [ { "field": "population", "quote": "recruited participants with chronic wounds" }, { "field": "intervention", "quote": "antimicrobial agents are evaluated" }, { "field": "primaryOutcome", "quote": "incorporated an objective assessment of wound healing" }, { "field": "result", "quote": "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." }, { "field": "result", "quote": "Several topical preparations may be helpful, including dimethyl sulphoxide, silver sulphadiazine, benzoyl peroxide, oxyquinoline and gentamicin." }, { "field": "limitations", "quote": "Small sample size and other methodological problems meant that findings were often difficult to interpret." } ] }, { "id": "pmid:11074391", "pmid": "11074391", "doi": null, "nctId": null, "pmcid": null, "title": "Systematic reviews of wound care management: (3) antimicrobial agents for chronic wounds; (4) diabetic foot ulceration", "firstAuthor": "O'Meara", "multipleAuthors": true, "journal": "Health Technol Assess", "year": 2000, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people with chronic wounds, including pilonidal sinuses", "intervention": "topical (and systemic) antimicrobial agents for chronic wounds", "comparator": "trials with a concurrent control group (type not specified for pilonidal sinus studies)", "primaryOutcome": "healing rates and recurrence of disease for pilonidal sinuses", "result": "abstract ends before reporting any specific antimicrobial results for pilonidal sinus patients", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "No pilonidal-specific result reported", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/11074391/", "sourceText": "BACKGROUND: Chronic wounds, including pressure sores, leg ulcers, diabetic foot ulcers and other kinds of wounds, healing by secondary intention are common in both acute and community settings. The prevention and treatment of chronic wounds includes many strategies, including the use of various wound dressings, bandages, antimicrobial agents, footwear, physical therapies and educational strategies. This review is one of a series of reviews, and focuses on the prevention and treatment of diabetic foot ulcers and the role of antimicrobial agents in chronic wounds in general. OBJECTIVES: To assess the clinical- and cost-effectiveness of (1) prevention and treatment strategies for diabetic foot ulcers and (2) systemic and topical antimicrobial agents in the prevention and healing of chronic wounds. METHODS - DATA SOURCES: Nineteen electronic databases were searched, including MEDLINE, CINAHL, Embase and the Cochrane Library. Relevant journals, conference proceedings and bibliographies of retrieved papers were hand-searched. An expert panel was consulted. METHODS - STUDY SELECTION: Randomised and non-randomised trials with a concurrent control group, which evaluated any intervention for the prevention or treatment of diabetic foot ulcers, or systemic or topical antimicrobials for chronic wounds (diabetic foot ulcers, pressure ulcers, leg ulcers of various aetiologies, pilonidal sinuses, non-healing surgical wounds, and cavity wounds) and used objective measures of outcome such as: (1) development or resolution of callus; (2) incidence of ulceration (for diabetic foot ulcer prevention studies); (3) incidence of pressure sores (pressure sore prevention studies); (4) any objective measure of wound healing (frequency of complete healing, change in wound size, time to healing, rate of healing); (5) ulcer recurrence rates; (6) side-effects; (7) amputation rates (diabetic foot ulcer treatment studies); (8) healing rates and recurrence of disease, among others, for pilonidal sinuses. Studies reporting solely microbiological outcomes were excluded. Decisions on the inclusion of primary studies were made independently by two reviewers. Disagreements were resolved through discussion. Data were extracted by one reviewer into structured summary tables. Data extraction was checked independently by a second reviewer and discrepancies resolved by discussion. All included studies were assessed against a comprehensive checklist for methodological quality. INCLUDED STUDIES - DIABETIC FOOT ULCERS: Thirty-nine trials which evaluated various prevention and treatment modalities for diabetic foot ulcers: footwear (2), hosiery (1), education (5), screening and foot protection programme (1); podiatry (1) for the prevention of diabetic foot ulcers; and footwear (1), skin replacement (2), hyperbaric oxygen (2), ketanserin (3), prostaglandins (3), growth factors (5), dressings and topical applications (9), debridement (2) and antibiotics (2) for the treatment of diabetic foot ulcers. INCLUDED STUDIES - ANTIMICROBIALS: Thirty studies were included, 25 with a randomised design. There were nine evaluations of systemic antimicrobials and 21 of topical agents. QUALITY OF STUDIES: The methodological and reporting quality was generally poor. Commonly encountered problems of reporting included lack of clarity about randomisation and outcome measurement procedures, and lack of baseline descriptive data. Common methodological weaknesses included: lack of blinded outcome assessment and lack of adjustment for baseline differences in important variables such as wound size; large loss to follow-up; and no intention-to-treat analysis. RESULTS - PREVENTION OF DIABETIC FOOT ULCERS: There is some evidence (1 large trial) that a screening and foot protection programme reduces the rate of major amputations. The evidence for special footwear (2 small trials) and educational programmes (5 trials) is equivocal. A single trial of podiatric care reported a significantly greater reduction in callus in patients receiving podiatric care. RESULTS - TREATMENT OF DIABETIC FOOT ULCERS: Total contact casting healed significantly more ulcers than did standard treatment in one study. There is evidence from 5 trials of topical growth factors to suggest that these, particularly platelet-derived growth factor, may increase the healing rate of diabetic foot ulcers. Although these studies were of relatively good quality, the sample sizes were far too small to make any definitive conclusions, and growth factors should be compared with current standard treatments in large, multicentre studies. Topical ketanserin increased ulcer healing rate in 2 studies, while systemic hyperbaric oxygen therapy reduced the rate of major amputations in 1 study. Preliminary research into the effects of iloprost and prostaglandin E1 (PGE1) on diabetic foot ulcer healing suggests possible benefits. However, good quality, large-scale confirmatory research is needed. (ABSTRACT TRUNCATED)", "provenance": [ { "field": "population", "quote": "diabetic foot ulcers, pressure ulcers, leg ulcers of various aetiologies, pilonidal sinuses, non-healing surgical wounds, and cavity wounds" }, { "field": "intervention", "quote": "systemic and topical antimicrobial agents in the prevention and healing of chronic wounds" }, { "field": "comparator", "quote": "Randomised and non-randomised trials with a concurrent control group" }, { "field": "primaryOutcome", "quote": "healing rates and recurrence of disease, among others, for pilonidal sinuses" }, { "field": "result", "quote": "(ABSTRACT TRUNCATED)" }, { "field": "quality", "quote": "The methodological and reporting quality was generally poor." } ] }, { "id": "pmid:7970033", "pmid": "7970033", "doi": null, "nctId": null, "pmcid": null, "title": "[Pilonidal cysts: the state of the art and the authors' personal experiences]", "firstAuthor": "Palmieri", "multipleAuthors": true, "journal": "Minerva Chir", "year": 1994, "design": "retrospective", "n": 53, "nField": "reported", "population": "patients with pilonidal cyst, average age 23, treated in a surgery department", "intervention": "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", "comparator": "no comparison group; patients compared before and after treatment, and relapsed cases treated again", "primaryOutcome": "whether the wound healed and whether the cyst came back after treatment", "result": "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", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "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.", "directness": "indirect", "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", "followUp": "at least 12 months", "plainFinding": "Cream only minor add-on, not tested alone", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/7970033/", "sourceText": "After a historical review of the pathogenesis and several therapies suggested for the treatment of pilonidal cysts the authors report the results of a retrospective study performed in the Department of Surgery during a period of four years, with at least 12 months follow-up. This study involved 53 patients (35 males and 15 females, 23 years average age) affected by pilonidal cyst. These patients were treated for a month with antibiotic therapy and underwent surgery by general anaesthesia. Before surgery blue methylene was injected in the cyst. Between 4 months and 2 years 5.7% of operated patients relapsed. After 10 days antibiotic therapy they underwent surgery again by local anaesthesia and then 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. These patients healed in a period between 4 weeks and 2 months. No relapses were observed after at least 12 months. In our opinion there is the rationale to suggest an open treatment of relapsed pilonidal cyst based on the use of heterologous lyophilized collagen and silver sulfadiazine: it is well accepted by the patient and effective in relapses.", "provenance": [ { "field": "n", "quote": "This study involved 53 patients (35 males and 15 females, 23 years average age) affected by pilonidal cyst." }, { "field": "population", "quote": "53 patients (35 males and 15 females, 23 years average age) affected by pilonidal cyst" }, { "field": "intervention", "quote": "These patients were treated for a month with antibiotic therapy and underwent surgery by general anaesthesia." }, { "field": "intervention", "quote": "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." }, { "field": "comparator", "quote": "Between 4 months and 2 years 5.7% of operated patients relapsed." }, { "field": "primaryOutcome", "quote": "These patients healed in a period between 4 weeks and 2 months. No relapses were observed after at least 12 months." }, { "field": "result", "quote": "These patients healed in a period between 4 weeks and 2 months. No relapses were observed after at least 12 months." } ] }, { "id": "pmid:3815041", "pmid": "3815041", "doi": "10.1002/bjs.1800740207", "nctId": null, "pmcid": null, "title": "Staphylococcal infection of open granulating wounds", "firstAuthor": "Marks", "multipleAuthors": true, "journal": "Br J Surg", "year": 1987, "design": "prospective-cohort", "n": 250, "nField": "reported", "population": "people with surgical wounds healing by open granulation, including armpit skin removal, abdominal surgery, and pilonidal sinus removal", "intervention": "Fucidin (fusidic acid) ointment used to treat infected armpit wounds", "comparator": "not stated", "primaryOutcome": "whether Staphylococcus aureus infection caused pain and delayed wound healing", "result": "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", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is an observational study of wound infection, not a trial testing cream treatment for pilonidal sinus specifically.", "directness": "indirect", "limitations": "No control group, no randomisation, and the cream treatment described applies to a different wound type (armpit) rather than pilonidal sinus wounds.", "followUp": "", "plainFinding": "Cream treated armpit infections, not pilonidal cysts.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/3815041/", "sourceText": "The significance of staphylococcal infection has been studied prospectively in 250 wounds healing by open granulation. In a series of 50 axillary skin excisions, 17 became infected with Staphylococcus aureus with consequent pain and delay in healing. The infections responded well to Fucidin ointment. Nasal carriers of the organism may be especially liable to this complication. In contrast, although S. aureus was not infrequently found in deep granulating wounds, there was no clear evidence of harm resulting in the 50 laparotomy wounds and 150 pilonidal sinus excisions studied. The susceptibility of superficial wounds to the infection is ascribed to friction from dressings. Deep granulating wounds are occasionally affected similarly when the cavity has filled.", "provenance": [ { "field": "n", "quote": "250 wounds healing by open granulation" }, { "field": "population", "quote": "50 axillary skin excisions" }, { "field": "population", "quote": "50 laparotomy wounds and 150 pilonidal sinus excisions studied" }, { "field": "intervention", "quote": "The infections responded well to Fucidin ointment." }, { "field": "primaryOutcome", "quote": "17 became infected with Staphylococcus aureus with consequent pain and delay in healing" }, { "field": "result", "quote": "there was no clear evidence of harm resulting in the 50 laparotomy wounds and 150 pilonidal sinus excisions studied" }, { "field": "comparator", "quote": "The significance of staphylococcal infection has been studied prospectively in 250 wounds healing by open granulation." } ] } ], "faqs": [ { "q": "Can I treat my pilonidal cyst with cream instead of surgery?", "a": "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." }, { "q": "Does zinc oxide cream help pilonidal wounds heal faster?", "a": "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." }, { "q": "Do hair-removal creams stop the cyst from coming back?", "a": "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." }, { "q": "Should I stop using the cream my doctor prescribed?", "a": "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." }, { "q": "What actually works for a pilonidal cyst or sinus?", "a": "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." } ], "patientTakeaway": "A cream cannot open, drain, or remove a pilonidal cyst or sinus — if it's painful, swollen, or leaking fluid, see a doctor, because most cases need a procedure to treat it properly. After surgery, certain dressings or creams may help the wound close, so ask your surgeon which one they recommend rather than picking one yourself.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"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])" }, "pubmedQueryTranslation": "(\"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])", "searchedOn": "2026-10-05", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Can Cream Treat a Pilonidal Cyst?", "description": "Reviewing 5 randomized trials and 3,001 people: creams alone do not cure a pilonidal cyst or sinus; most cases still need surgery or drainage." }, "lastChecked": "2026-10-05", "lastChanged": "2026-10-05", "nextCheckDue": "2026-11-05", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-05" }, "status": "published" }