Why Muprocin, Bactroban, Neosporin, and Polysporin are not a solution for pilonidal sinus disease
Patients with pilonidal disease are often advised to apply antibiotic ointments such as mupirocin, bacitracin, Polysporin, or Neosporin. Although this seems logical, these products will not effectively treat a pilonidal sinus. One reason that these may appear to be helping is that pilonidal disease naturally cycles. Symptoms may worsen for a period of time and then improve on their own. If a patient starts using an ointment during a flare-up and the symptoms subsequently settle down, it is easy to conclude that the ointment caused the improvement. However, the disease was likely following its normal pattern.
Pilonidal Disease Is Not Primarily an Infection
A pilonidal sinus is a chronic tract beneath the skin. It persists because of the tunnel shape of the sinus, the presence of hair and debris, and the anatomy of the gluteal cleft. Bacteria may be present within the sinus, but they are not the primary cause of the problem. This is an important distinction. Treating the bacteria does not eliminate the sinus any more than putting antibiotic ointment on a splinter would make the splinter disappear.
Why Antibiotic Ointments Fail
Antibiotic ointments are designed to treat certain bacterial skin infections. A pilonidal sinus is not a bacterial skin infection. Even if an antibiotic ointment could completely eliminate every bacterium within the sinus, the sinus tract would still be present. The underlying disease would remain unchanged.
For this reason, patients commonly experience the same pattern:
- Symptoms flare up
- An ointment is applied
- Symptoms improve and the sinus drains
- Weeks or months later the symptoms return
The recurrence occurs because the sinus was never eliminated.
Pilonidal disease naturally cycles. Improvement after starting an ointment does not necessarily mean the ointment caused the improvement.
What Actually Treats a Pilonidal Sinus?
Successful treatment must address the sinus itself.
Depending on the situation, this may involve:
- Removal of hair and debris
- Drainage of an abscess
- Pit-picking procedures
- A cleft lift procedure
- Other treatments directed at eliminating the sinus and correcting the deep cleft anatomy that contributes to the disease
Conclusion
Antibiotic ointments do not cure pilonidal disease because a pilonidal sinus is not primarily an infection. The apparent success of these ointments is often explained by the natural tendency of pilonidal disease to improve and worsen in cycles. When symptoms return, it becomes clear that the underlying sinus was never actually treated.
Note: This discussion is specifically about ointments used to treat sinus tract openings, pilonidal abscess drainage sites, or cysts. There are times, with small wounds near the anus, that we use a specific strength of Metronidazole Ointment to get these wounds to heal. More about that by following this link.
