What is the role of phenol injections in the treatment of pilonidal disease?

Updated: Jun 11, 2018
  • Author: M Chance Spalding, DO, PhD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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In Europe it is much more common to treat pilonidal sinuses with phenol injections [14, 15, 16] than it is in the United States. Both chronic pilonidal disease and acute pilonidal abscess (after incision and drainage) may be managed by phenol injection.

In this procedure, 80% phenol is injected into the sinus, left there for 1 minute, and then expressed out of the cavity. The sinus is then curetted. This can be repeated as many as three times, for a total of 3 minutes of phenol exposure during a single treatment. The treatments may be repeated every 4-6 weeks as necessary, as wound healing progresses. Paraffin jelly may be used to protect the skin from the phenol, which destroys the epithelium.

Phenol sterilizes the sinus tract and removes embedded hair. Phenol injections may be combined with local excision of the sinus. Wound healing usually requires 4-8 weeks. The incidence of recurrence is reported to be in the range of 9-27%, which is similar to the incidence following simple excision and packing open the wound.

Because of the intense local inflammatory response after the phenol injection, patients usually stay in the hospital overnight. Thereafter, the patient is allowed to return home, with instructions to bathe daily and follow a postoperative hair removal regimen, including shaving of the surrounding areas on a near-daily basis. Dressings are used for comfort.

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