Pilonidal sinus disease is an acquired skin condition of chronic inflammation in the sacrococcygeal region, characterised by fistulae, pain, and swelling. Fistulae in the condition are recessed with a narrow opening at the skin’s surface (pilonidal sinuses). In most cases, the cavity is filled with hair nests. While 58% of cases will resolve within 5 weeks, the condition is problematic because of the common recurrence ulcers in around 40% and 50% of cases, because it is a condition with a high reoccurrence rate, it is generally difficult to treat. Surgery is the mainstay of treatment and there is no medical consensus regarding adjunctive treatment options for pilonidal sinus disease.

The resin obtained from the bark of Boswellia sacra (Frankincense or Olibanum) has been studied for the treatment of several different pathologies including skin infections, ulcerative colitis, and cancer, and for reducing inflammation. Due to its antiseptic, anti-arthritic and anti-inflammatory effects and its uses for reducing inflammation and encouraging healing in traditional medical systems, it may be of utility in the treatment of pilonidal sinus disease (PNS). To our knowledge, there have been no studies on the use of B. sacra for the treatment of PNS, but it has been used in traditional medicine systems for similar conditions characterised by inflammatory wounds.

Thus, the objective of this case study is to indicate a potential, novel treatment based on traditional medicine – Olibanum – with rapid resolution of pilonidal sinus disease following the use of this treatment both orally and topically in conjunction with diet and lifestyle interventions.