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Eur J Dermatol. 2010 Jul-Aug;20(4):476-81. Epub 2010 Apr 21.
Effectiveness of topical use of natural polyphenols for the treatment of sacrococcygeal pilonidal sinus disease: a retrospective study including 192 patients.
Aksoy HM, Aksoy B, Egemen D.

Abstract
Sacrococcygeal pilonidal sinus disease (SPSD) is a common disorder. None of the current treatment methods seems to be the ideal treatment for SPSD. In this study, we evaluated the effectiveness of polyphenols produced from the components of natural organic matter in soil in the treatment of SPSD. One hundred and ninety two patients with SPSD who used topical polyphenols for the treatment of their disease were studied retrospectively. Information on the characteristics of patients and treatment and results of treatment were obtained from the patient files and/or by telephone surveys. The median duration for total treatment was 12 weeks and the mean follow up period was 22 months. One hundred and sixty six (86.5%) patients got benefit from the treatment. Fifty one (26.6%) patients had minor temporary side effects. In 64 (33.3%) patients SPSD relapsed. Patients were able to continue their normal daily activities during the treatment period and there was no loss of work days. Locally applied natural polyphenols are one step in the direction of finding an ideal treatment of SPSD. They are easy to apply, cheap, safe and associated with a low risk of complications. Their use was not associated with time off work, unnecessary hospital stay or any anatomical distortion of the natal cleft.
PMID: 20406728 [PubMed – indexed for MEDLINE]

Med Princ Pract. 2010;19(3):212-5. Epub 2010 Mar 29.

Investigation of a one-time phenol application for pilonidal disease.

Kayaalp C, Olmez A, Aydin C, Piskin T, Kahraman L.
Department of General Surgery, Inonu University, and Beydagi State Hospital, Malatya, Turkey. cuneytkayaalp@hotmail.com
Comment in:
• Med Princ Pract. 2010;19(3):216-7.
Abstract
OBJECTIVE: To investigate wound healing rates and postoperative recovery of patients after a one-time phenol application for pilonidal disease.
SUBJECTS AND METHODS: A total 30 consecutive patients with chronic pilonidal disease ranging from midline to complex sinuses were enrolled in the study. No preoperative laboratory examinations or bowel preparation were required. No antibiotic prophylaxis or sedation was used. A small incision was made on the midline and hair/debris in the sinuses was removed. A cotton swab with saturated phenol was moved into the cavity and the phenol was left for 2 min. No special dressing was necessary and patients left the hospital immediately afterwards. Patients filled out a daily questionnaire for 7 days. We did not intervene in the wounds with a second phenol application or curettage during the observation period. Wounds were inspected at weekly intervals for 2 months.

RESULTS: At the end of the third day, 97% of the patients were pain-free and 100% of the patients were free from analgesics. Time off work was 2 days for most patients (93.3%). Twenty-eight (93.3%) patients were satisfied with the procedure, they found it easy and painless and suggested the procedure to other patients. Twenty-five (83%) patients were asymptomatic at the end of 2 months’ observation and the remaining 5 patients had unhealed sinuses. Mean time for wound healing was 25 days (range 10-63 days). There were 4 recurrences after a mean of 14 months’ follow-up and the overall success rate was 70%.

CONCLUSIONS: A one-time phenol application was an effective treatment for pilonidal disease with acceptable wound healing rates, less postoperative pain and less time off work. Hence it can be an alternative treatment modality.
Copyright (c) 2010 S. Karger AG, Basel.

PMID: 20357505 [PubMed – indexed for MEDLINE]

Acta Chir Belg. 1985 Sep-Oct;85(5):325-8.

Pilonidal sinus. Excision–marsupialization–phenolization

Duchateau J, De Mol J, Bostoen H, Allegaert W.
Abstract
Too often still this disease is called sacrococcygeal cyst, pointing into the direction of congenital etiology. With this paper (and a review of the literature) we try to proof that the theory of acquired origin of pilonidal sinus is the only one logically to be accepted. We indicate that extensive surgical procedures such as Z-plasty rotated flap or broad excision–are really unnecessary and that a simple and accurate technique–marsupialization–gives excellent results with a minimum of recurrences. The last few years phenolization of the pilonidal sinus has become a popular, and eventually a worthwhile alternative.

PMID: 4082855 [PubMed – indexed for MEDLINE]

Surgery. 1987 Jul;102(1):52-4.

Treatment of complicated or infected pilonidal sinus disease by local application of phenol.

Hegge HG, Vos GA, Patka P, Hoitsma HF.
Abstract
This article reports on the results of conservative treatment of 48 patients with complicated pilonidal sinus disease. The treatment consisted of an injection of phenol 80% into the sinus tract after the patients had undergone depilation and excavation while under local anesthesia. The number of phenol injections in each patient varied from one to nine (mean: two injections). Patients were considered cured if no signs of recurrent pilonidal sinus disease occurred within 1 year after treatment. The mean follow-up period after cure was 3 years (range: 1 to 6 years). The recurrence rate was 6.3% (a 95% confidence interval of 1.3% to 17.2%), which was one of the lowest reported for different methods of treatment for pilonidal sinus disease. The good results in this study justify continuation of conservative treatment of pilonidal sinus disease, especially in view of the low costs and the high degree of patient comfort. Sclerosing therapy with phenol is thus recommended as a successful treatment for complicated pilonidal sinus disease.

PMID: 3589976 [PubMed – indexed for MEDLINE]

Ulster Med J. 1989 Apr;58(1):56-9.
Treatment of pilonidal sinus by phenol injection.
Kelly SB, Graham WJ.
Abstract
This report reviews the treatment of pilonidal sinus by phenol injection in 54 patients. Forty-four patients were treated initially by phenol injection and this was successful in 70%. The median number of injections per patient was one (range 1-5) with a median hospital stay per injection of two days (range 1-17 days). The median time to complete healing for patients treated by injection alone was two months (range 1-32 months). These results compare very favourably with more radical methods of treatment.

PMID: 2773172 [PubMed – indexed for MEDLINE]PMCID: PMC2448552Free PMC Article

Zentralbl Chir. 1990;115(12):777-80.
Phenol treatment of pilonidal sinuses.
Vara-Thorbeck R, Mekinassi K, Berchid S.
Surgical Department, Medical Faculty Granada.
Abstract
Pilonidal disease of the natal cleft is a common condition responsible for much morbidity. The results of phenol injection used in 67 patients treated in our Department of Surgery between 1986-1988 are reviewed. Our study shows that this procedure is an effective treatment. Phenol injection of pilonidal sinuses is a simple operation and produces results which are similar those achieved by surgical procedures but has the advantages of a shorter inpatient stay (1-3 days) with a prompt return to work (1-2 weeks).

PMID: 2385975 [PubMed – indexed for MEDLINE]

Int J Colorectal Dis. 1994;9(4):200-2.
Treatment of pilonidal sinuses by phenol injections.
Schneider IH, Thaler K, Köckerling F.
Surgical Clinic, University of Erlangen-Nürnberg, Germany.
Abstract
Six female and 39 male outpatients, who suffered from acutely inflamed pilonidal sinus were treated by sclerotherapy between January 1985 and December 1988. Under local anaesthesia, 1-2 ml 80% phenol was injected into the sinus. The phenol, which was allowed to act for a minute, was washed out by irrigating the sinus with physiological common-salt solution. Of the questionnaire sent to all 45 patients, 37 proved suitable for evaluation. Complete healing occurred in 22 cases (59.8%). The healing time was 6.2 weeks on average. Besides a rather frequently observed transient reddening as a result of the local inflammation caused by the phenol, 5 patients developed an abcess which needed operative treatment. This study does not support the encouraging results of previous series.

PMID: 7876724 [PubMed – indexed for MEDLINE]

Dis Colon Rectum. 2004 Nov;47(11):1934-8.
Pilonidal sinus treated with crystallized phenol: an eight-year experience.
Dogru O, Camci C, Aygen E, Girgin M, Topuz O.
Department of General Surgery, Firat University School of Medicine, Elazig, Turkey. odogru@firat.edu.tr
Abstract
PURPOSE: The aim of this study was to determine the impact of crystallized phenol on the outpatient treatment of pilonidal disease.
PATIENTS AND METHODS: A retrospective analysis was undertaken of patients seen in the outpatient surgery clinic of the University Hospital, Elazlg, Turkey. Age, gender, body mass index, characteristics of sinuses at initial presentation, and the recovery time of 41 patients were analyzed. The relationship between recovery time and the number of sinus openings, presence of abscess, and status of the sinuses (acute vs. chronic) were noted.
RESULTS: Crystallized phenol was applied a total of 107 times on 41 patients. Seventy percent of the patients had two to three applications. Mean recovery time was 42.7 (+/- standard deviation of 24) days with a range of 13 to 120 days. Recurrences were observed in only two patients at the fifth and eighth months following recovery. The success rate was 95.1 percent. Median follow-up was 24 (range, 6-98) months. The status of sinuses (acute vs. chronic and presence or absence of abscess) and the number of sinus opening had no effect on recovery time (P > 0.005).
CONCLUSION: Crystallized phenol treatment is a simple and inexpensive method that can be readily applied on an outpatient basis, decreasing both the recurrence rate and lost work time. We suggest that this method be considered the first-line treatment of any type of pilonidal sinus.

PMID: 15622588 [PubMed – indexed for MEDLINE]

Tech Coloproctol. 2005 Apr;9(1):21-4.
Treatment of pilonidal sinus by phenol application and factors affecting the recurrence.
Kaymakcioglu N, Yagci G, Simsek A, Unlu A, Tekin OF, Cetiner S, Tufan T.
Department of General Surgery, Gulhane Military Medical Academy, Etlik, Ankara, Turkey. gyagci@gata.edu.tr
Abstract
BACKGROUND: Phenol injection, a less invasive method, has become more popular for the treatment of sinus pilonidalis. Recurrence rates after the use of phenol have been reported to be less than those after other surgical methods.
METHODS: In this study, we applied 80% phenol to 143 patients with sinus pilonidalis. Patients were reevaluated at 1, 3, 6, 12 and 24 months after the phenolization procedure to search for any recurrences. Age, sex, skin color, occupation, hair distribution, complaints, macroscopic characteristics of the lesion, pouch volume, microbiological yield, complications of phenol injection, healing time, and recurrences were determined.
RESULTS: The mean follow-up period was 24 months and the recurrence rate was 8.3% (12 of 143 patients). Volume of the sinus tract and number of sinus orifices were determined to be the factors significantly affecting recurrences (p<0.05).
CONCLUSIONS: Injection of 80% phenol is an ideal approach for the conservative treatment of sinus pilonidalis. This study confirms that this is an effective and costless method with low recurrence rates.

PMID: 15868494 [PubMed – indexed for MEDLINE]

Tech Coloproctol. 2009 Sep;13(3):189-93. Epub 2009 Aug 5.
Review of phenol treatment in sacrococcygeal pilonidal disease.
Kayaalp C, Aydin C.
Department of General Surgery, Turgut Ozal Medical Center, Inonu University, Malatya, Turkey. cuneytkayaalp@hotmail.com
Abstract
BACKGROUND: Investigating minimally invasive methods for treatment of pilonidal disease, we reviewed the techniques and the results of phenol treatment of pilonidal disease in the medical literature.
METHODS: A Pubmed search for all English language written papers and abstracts published between January 1964 and September 2007.
RESULTS: Mean time to return to work is 2.3 +/- 3.8 days and mean healing time is 20 +/- 14 days. Overall success rate is 87 +/- 10% with a mean follow-up of 2.0 +/- 1.1 years. The most common postoperative complications after phenolization are development of abscesses and cellulites. The incidence of morbidities was mean 8.9 +/- 4.7%.
CONCLUSIONS: Success rate looks better particularly in the cases that have 1-3 sinus orifices and comparable with the surgical methods. Though healing time of the wound is long, the procedure apparently lessens the time off work. Although results of this review indicate that phenol treatment may be beneficial for pilonidal disease, the lack of randomized studies results in only weak evidence. There is also the need for longer-term follow-up data.

PMID: 19655223 [PubMed – indexed for MEDLINE]

Med Princ Pract. 2010;19(3):212-5. Epub 2010 Mar 29.
Investigation of a one-time phenol application for pilonidal disease.
Kayaalp C, Olmez A, Aydin C, Piskin T, Kahraman L.
Department of General Surgery, Inonu University, and Beydagi State Hospital, Malatya, Turkey. cuneytkayaalp@hotmail.com
Comment in:
• Med Princ Pract. 2010;19(3):216-7.
Abstract
OBJECTIVE: To investigate wound healing rates and postoperative recovery of patients after a one-time phenol application for pilonidal disease.
SUBJECTS AND METHODS: A total 30 consecutive patients with chronic pilonidal disease ranging from midline to complex sinuses were enrolled in the study. No preoperative laboratory examinations or bowel preparation were required. No antibiotic prophylaxis or sedation was used. A small incision was made on the midline and hair/debris in the sinuses was removed. A cotton swab with saturated phenol was moved into the cavity and the phenol was left for 2 min. No special dressing was necessary and patients left the hospital immediately afterwards. Patients filled out a daily questionnaire for 7 days. We did not intervene in the wounds with a second phenol application or curettage during the observation period. Wounds were inspected at weekly intervals for 2 months.
RESULTS: At the end of the third day, 97% of the patients were pain-free and 100% of the patients were free from analgesics. Time off work was 2 days for most patients (93.3%). Twenty-eight (93.3%) patients were satisfied with the procedure, they found it easy and painless and suggested the procedure to other patients. Twenty-five (83%) patients were asymptomatic at the end of 2 months’ observation and the remaining 5 patients had unhealed sinuses. Mean time for wound healing was 25 days (range 10-63 days). There were 4 recurrences after a mean of 14 months’ follow-up and the overall success rate was 70%.
CONCLUSIONS: A one-time phenol application was an effective treatment for pilonidal disease with acceptable wound healing rates, less postoperative pain and less time off work. Hence it can be an alternative treatment modality.
Copyright (c) 2010 S. Karger AG, Basel.

PMID: 20357505 [PubMed – indexed for MEDLINE]

Dis Colon Rectum. 2010 Jun;53(6):932-5.
Crystallized phenol in nonoperative treatment of previously operated, recurrent pilonidal disease.
Aygen E, Arslan K, Dogru O, Basbug M, Camci C.
Department of Surgery, Firat Euphrates University School of Medicine, Elazig, Turkey.
Abstract
PURPOSE: Recurrence after surgery for pilonidal disease remains a challenge. We investigated the application of crystallized phenol as a nonoperative treatment for patients with recurrent, previously operated pilonidal disease.
METHODS: Participants were patients treated for recurrent pilonidal disease at our clinics from January 1995 through August 2007. Crystallized phenol was administered on an outpatient basis. Patient and disease characteristics including age, gender, body mass index, occupation, family history, time from previous operation to recurrence and to phenol treatment, number and type of previous operations, and characteristics of recurrent sinuses at entry were prospectively recorded. Outcome variables included number of phenol applications, recovery time, recurrence, and treatment success or failure.
RESULTS: A total of 36 patients with recurrent pilonidal disease were treated with crystallized phenol (mean recurrence time after previous surgery, 16.2 +/- 4.6 months; number of previous operations, 1.47 +/- 0.9). The mean number of phenol applications per patient was 3.7 +/- 1.3 (range, 1-7). No serious side effects were observed. Exfoliation of a 2-cm area around the sinus openings in 3 patients (8.3%) was easily treated with ointments locally; patients reported minimal pain. Healing was obtained in all patients in a median of 48 (range, 10-153) days. During follow-up (mean duration, 54.4 +/- 5.2 months; range, 29-169 months), 31 patients (86.1%) had no recurrence and 5 patients (13.9%) had recurrence. Recurrent sinuses were successfully treated by a second course of crystallized phenol in 2 patients, 1 patient refused retreatment, and healing was not obtained with a second treatment course in 2 patients, yielding an overall success rate of 91.7% and failure rate of 8.3%.
CONCLUSION: Crystallized phenol application is a simple, inexpensive nonoperative procedure that can be performed in an outpatient setting and is suitable for the treatment of previously operated recurrent pilonidal disease.

PMID: 20485008 [PubMed – indexed for MEDLINE]

JRSM Short Rep. 2010 Jun 30;1(1):5.
Comparison of the application of low concentration and 80% phenol solution in pilonidal sinus disease.
Sakçak I, Avşar FM, Coşgun E.
Department of General Surgery, Numune Teaching and Research Hospital , 06100, Ankara , Turkey.
Abstract
OBJECTIVES: Many conservative methods have been applied in the treatment of pilonidal sinus disease (PSD). The most commonly used conservative treatment is 80% phenol solution. Our observations demonstrated that 80% phenol solution caused much destruction in the sacrococcygeal region.
DESIGN: In this study low concentrations of phenol were used with the aim of reducing the unwanted side-effects of high-concentration phenol without reducing the therapeutic effects.
PARTICIPANTS: We treated 112 patients (18 women, 94 men) with PSD using phenol solution. Patients were divided into two groups: Group A was treated with a 40% solution of phenol solution, and Group B was treated with an 80% solution of phenol solution.
SETTING: All patients were treated on an outpatient basis. One mL of low (40%) or high (80%) concentration phenol solution was injected into the main sinus orifice. During the check it was observed and noted whether there was skin necrosis, fatty tissue necrosis or abscesses.
MAIN OUTCOME MEASURES: The mean age was 27.4 years (6-44). The median length of symptoms was seven months (0.5-132). In the 2.8 years (1-6) of mean follow-up period, the disease recurred in 13 (11.6%) patients.
RESULTS: This treatment procedure was well-tolerated by all the patients except for those who had unwanted results. No patients in group A had skin necrosis, and only one had abscesses. In group B two patients had abscesses, and three had skin necrosis. Fatty tissue necrosis was seen in one patient in Group A and in five patients in Group B. Recurrence rates were four (7.4%) cases in Group A and nine (15.5%) cases in Group B.
CONCLUSIONS: It is possible to treat patients in a shorter time with a considerably smaller loss of working time, since the destruction of peripilonidal adipose tissue and skin is less. Therefore, the use of low-concentration phenol solution is an option to be considered in the treatment of PSD.
PMID: 21103097 [PubMed – in process]PMCID: PMC2984340Free PMC Article

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