Conservative Treatments

What is a "conservative" treatment? As defined here, we consider conservative to be treatment plans that do not rely on extensive removal of tissue. Conservative treatments as advocated on this site revolve around the experience of Dr. John Bascom, who performed 600+ Pilonidal surgeries over the course of his career and is widely regarded as the foremost expert in the world on the disease.

Bascom has found only a couple of actual cysts in the more than 600 Pilonidal surgeries he has performed. A true cyst, does need to be fully removed (excised). An abscess, however, only needs to be drained and the source of the infection needs to be removed (which is the pit). Pathologists and surgeons on rare occasions find the sac is lined with epidermis, made up of cells from skin, but only cells from the outer layer of skin. That outer layer, which we call epidermis, contains no follicles. Pathologists find epidermis lines the sac only in rare late cases where epidermis has crept into a long-standing abscess in an attempt to heal it. They never find a sac lined with intact skin and follicles, only an occasional sac lined with epidermis.

Cyst: A closed sac or capsule, usually filled with fluid or semisolid material.

Abscess: A local accumulation of pus anywhere in the body, formed by tissue disintegration and surrounded by an inflamed area.

Based on Dr. Bascom's experience, the opinion of this organization that the first treatments lean towards the conservative side. It is easy to move forward from a pit-picking or other more conservative treatment -- and impossible to "go back" from a failed excision surgery.

So, the bottom line (no pun intended) is WHY SURGICALLY REMOVE A HUGE CHUNK OF TISSUE THAT WOULD OTHERWISE HEAL NATURALLY ONCE THE SOURCE OF INFECTION IS REMOVED? Most anyone who has read this site has seen numerous examples of Pilonidal excisions that have failed to heal, recurred, and generally turned the lives of some people in to a living hell. This is the reason for the "conservative" movement towards non-excision treatment. These techniques are not new, they have been around since the 60's.

Pit Picking

The basic premise of Pit Picking

open up the abscess (lancing)
clean it out (and is some cases, brush the tracts)
remove the pit(s) - this may need to happen 10 days after the lancing so the swelling has subsided
leave the deep tissues intact
let it heal

Most studies quote that 85% of patients require further surgical treatment after a lancing. Excising the Pilonidal pit at the time of lancing reduces the recurrence rate to 15%. The difficulty with doing this is that the Pilonidal pit initially cannot be identified during the first drainage procedure of the abscess due to swelling. Approximately 10 days later, when the swelling is reduced, the pit(s) can be identified and excised.

A basic guide to Pit Picking.

For more detail on various published studies by Bascom and others, please visit our Education Center.

Phenol Injection

What it is - Phenol is an aromatic alcohol, it exhibits weak acidic properties and is corrosive and poisonous; it is sometimes called carbolic acid. Phenol causes wide spread tissue destruction in the injected area, including coagulation of nerves and muscle death. It is currently used very selectively for facial peels. For Pilonidal treatment it is injected into the cyst and sinuses in hopes that it will burn the tissues to the point that they no longer become infected.

Where it's done - At the doctor's office.

Recovery time - A few days.

What else you should know - Phenol Injection was at one time a promising potential cure for Pilonidal Disease. The idea was to damage the tissue to induce scarring, which would prevent further infections. Scar tissue has no pores or follicles to get infected... After further experimentation, the treatment was dropped as disease recurrences began cropping up, indicating that the underlying problem had not been solved. Most doctors won't bother with this treatment anymore and it is usually only found being used in Europe.

One other note: Phenol Injection was one of the techniques used to murder prisoners at Auschwitz, the drug was injected directly into the heart and caused death in approximately two minutes.

This page last updated: 11/03/2010

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