Do pilonidal cysts go away?

Sometimes symptoms settle down on their own, as seen in one reported case, but there is no good study showing how common this is. Most of the research available looks at treatments, not at cysts left completely alone.

Will a pilonidal cyst go away by itself?

There's no reliable evidence to promise this. Some people may see symptoms ease temporarily, as in the one reported case, but it can also come back, and the cyst may still eventually need treatment.

How long does it take for a pilonidal cyst to go away?

No study has measured this. The single case report that describes spontaneous improvement doesn't give a clear timeline, so there's no evidence-based answer to how long it takes.

Should I just wait and not treat it?

The evidence doesn't support confidently waiting it out, since no trial has tested true watchful waiting against treatment. If symptoms worsen, spread, or you develop a painful swelling, that's a sign to see a doctor rather than wait.

Can a pilonidal cyst go away on its own?

Name: Can a pilonidal cyst go away on its own?
Published: 2026-10-13
Keywords: do pilonidal cysts go away, can a pilonidal cyst go away on its own, will a pilonidal cyst go away by itself, how long does it take for a pilonidal cyst to go away

In patients with a pilonidal cyst or sinus, what proportion resolve without surgical intervention, and how long does spontaneous resolution take compared with recurrence after non-operative management?

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Evidence review in plain language · compiled 2026-10-13 · checked 2026-10-13 · next 2026-11-13 · automated review, how it works

Bottom line

A pilonidal cyst can sometimes settle down without surgery, but the evidence for this is extremely thin.

The only study that actually watched an untreated cyst over time is a single case report of a pregnant woman, whose symptoms came and went on their own before she eventually had surgery. Other studies looked at treatments like hair removal, antibiotics, or surgery versus each other — not at what happens if you simply leave a cyst alone — so there is no reliable number for how often cysts resolve by themselves or how long that takes.

How certain

Very low

The only direct evidence is 1 small or uncontrolled study.

What it shows

Possible benefit

The evidence points to a benefit, but it is not strong enough to be confident.

studies found: 15studies found
randomised trials: 0randomised trials
people studied: 31,900people studied
review of trials: 1review of trials
years covered: 2023–2026years covered

What the research shows

Spontaneous resolution rate (cyst goes away with no treatment at all)
Only one case has been reported in which symptoms resolved without any treatment — and they later came back. This is not enough to give a percentage or a reliable answer.[1]
Insufficient evidence
Time to resolution of symptoms
No study tracked how long it takes for an untreated cyst to settle down. The one case report does not give a clear timeline either.[1]
Not studied
Recurrence rate after conservative (non-surgical) management
In two studies, recurrence after non-surgical care (hair removal, in-clinic care) was similar to or lower than after surgery, but the groups compared were not randomly assigned, so this may reflect milder cases being managed without surgery rather than a true benefit.[1,2]
Possible improvement
Progression to abscess requiring drainage
No study measured how often an untreated cyst turns into a painful abscess that needs draining.
Not studied
Need for eventual surgery after trying non-surgical care
In small studies of laser hair removal, some patients avoided surgery entirely, and most of those who still needed it were cured with one operation. These studies tested an active treatment, not simply waiting.[1,2]
Possible improvement
Symptom-free interval duration
No study reported how long symptom-free periods typically last without treatment.
Not studied

What it may help with

In one case report, a pregnant woman's pilonidal symptoms resolved on their own twice, without any treatment, though they returned each time.[1]
In young patients who were symptom-free, regular hair removal alone led to a similar recurrence rate as surgery plus hair removal, suggesting that avoiding surgery doesn't necessarily mean worse outcomes for mild cases.[1]

Important limitations

There are no randomized trials on this question at all — every study is observational, meaning other differences between groups (not the treatment itself) could explain the results.[1,2,3,4,5,6,7,8]
The only study that followed an untreated cyst over time, rather than comparing treatments, is a single case report. One person's experience cannot tell us what usually happens.[1]
Most studies tested an active treatment (hair removal, antibiotics, surgery) rather than true watchful waiting with nothing done, so they can't answer whether cysts resolve with no intervention at all.[1,2,3,4]
Populations studied were often specific groups — children, military service members, or pregnant patients — which may not reflect the average adult asking this question.[1,2,3]

What the studies found

Found a benefit6 · 40%
Found no clear effect1 · 7%
Mixed or unclear8 · 53%

What kind of studies

Prospective cohort4 · 27%
Retrospective3 · 20%
Narrative review3 · 20%
Case series3 · 20%
Registry1 · 7%
Meta-analysis1 · 7%

The studies that decided it

Donnelly et al. 2026
Minimally Invasive, Maximally Effective: Outpatient Strategies for Paediatric Pilonidal Disease
Conservative care had fewer recurrences than surgery.RetrospectiveLow qualityRelated question
69 people2026
recurrence happened in 26.1% of patients who had surgery versus 2.2% of patients managed without surgery
Who was studied
children and teenagers up to 18 years old with pilonidal sinus disease
What they received
structured outpatient care including conservative treatment and in-clinic debridement
Compared with
operative treatment (trephination or limited excision)
Main outcome
recurrence after the wound had healed
Quality
This was a single-centre retrospective study where the surgical group likely had more severe disease to begin with, so the comparison may be biased rather than a fair test of treatments.
Limitations
Retrospective design, single centre, and the authors note that patients undergoing operative intervention likely represented a more severe subgroup, meaning the groups may not be comparable.
Taken word for word from the abstract
- n 69 patients were included
- population patients aged ≤ 18 years treated for PNS between February 2023 and August 2024
- intervention structured conservative care, in-clinic debridement
- comparator operative intervention (trephination or limited excision) for refractory or severe disease
- primaryOutcome Primary outcome was recurrence after documented healing
- result Recurrence occurred in 6/23 (26.1%) in the operative group and 1/46 (2.2%) in the non-operative group (Fisher's exact p = 0.0045)
Int Wound J · PMID 42020338 · Read it on PubMed ↗
Griffiths et al. 2026
Pilonidal Disease: A Recent Decade of the Disease among Active Duty United States Military Service Members
Many cysts persisted without surgery.RegistryLow qualityRelated question
25,039 people2026
About half of cases without initial surgery were still diagnosed again later, and surgery itself had a high repeat-diagnosis rate
Who was studied
active duty U.S. military service members diagnosed with pilonidal disease
What they received
no procedure performed at first diagnosis (watchful approach)
Compared with
procedure performed at first diagnosis
Main outcome
healthcare utilization and disease recurrence/persistence patterns
Quality
This is a retrospective review of military medical records without a control group, so it can't reliably show whether cysts resolve on their own.
Limitations
Abstract does not describe study design limitations beyond being a retrospective database review; no comparison group for natural resolution without any treatment.
Taken word for word from the abstract
- n 25,039 active duty service members were diagnosed with an incident case of PD
- population active duty U.S. service members with at least one PD diagnosis in the MHS Data Repository
- intervention persistent (no procedure performed at incident encounter)
- comparator recurrent (procedure performed at incident encounter)
- primaryOutcome to identify the burden of PD and describe current healthcare utilization and treatment patterns in the MHS
- result Prevalence of recurrence was 44.6% (2,494 of 5,598) and persistence was 50.1% (9,731 of 19,441).
Mil Med · PMID 41631611 · Read it on PubMed ↗
Chiu et al. 2025
Standardized Classification System for Pilonidal Disease and Recurrence Rate after Treatment
Higher-stage disease recurs more after treatment.Prospective cohortModerate qualityRelated question
411 people1- and 2-year follow-up
recurrence rates rose with higher PDS stage: at 1 year 0.0%, 2.3%, 8.3%, and 20.8% for stages 0, I, II, III; at 2 years 0.0%, 4.8%, 12.7%, and 27.5%
Who was studied
patients presenting with pilonidal disease at a specialized pilonidal care center
What they received
being classified at a higher pilonidal disease severity (PDS) stage at initial presentation
Compared with
lower PDS stages (0, I, II) at initial presentation
Main outcome
pilonidal disease recurrence at 1- and 2-year follow-up
Quality
It is a single-center prospective study with substantial loss to follow-up (only about half of patients completed 2-year follow-up), so results may not generalize.
Limitations
Only 212 of 411 patients completed 1-year follow-up and 206 completed 2-year follow-up; single specialized center.
Taken word for word from the abstract
- n A total of 411 patients met criteria, with 212 and 206 patients completing 1- and 2-year follow-up, respectively.
- population All patients presenting with pilonidal disease were included.
- intervention The main effector under study was PDS stage assigned at initial presentation.
- comparator recurrence occurred in 0.0%, 2.3%, 8.3%, and 20.8% of patients with PDS stage 0, I, II, and III disease at initial presentation
- primaryOutcome The primary outcome was pilonidal disease recurrence at 1- and 2-year follow-up.
- result recurrence occurred in 0.0%, 2.3%, 8.3%, and 20.8% of patients with PDS stage 0, I, II, and III disease at initial presentation, respectively (log-rank test, p = 0.017). At 2 years, recurrence was noted in 0.0%, 4.8%, 12.7%, and 27.5% of patients with PDS stage 0, I, II, and III disease, respectively (log-rank test, p = 0.010).
J Am Coll Surg · PMID 40401769 · Read it on PubMed ↗
Janek et al. 2025
Laser Hair Removal May Be a Primary Treatment of Pilonidal Disease: A Pilot Study
Laser hair removal, not no treatment, helped some patients avoid surgery.Prospective cohortLow qualityRelated question
22 people18 months
40% of patients who finished laser treatment had their disease resolve without needing surgery; of those who still needed surgery, 67% were cured after one operation
Who was studied
teens and young adults ages 13-35 with moderate to severe pilonidal disease who were going to need surgery
What they received
laser hair removal using an Alexandrite laser, given before surgery was tried
Compared with
no comparison group; outcomes tracked over time in the same patients
Main outcome
whether the disease went away without surgery, and whether it came back after surgery
Quality
This was a small pilot study with no comparison group, so it can't tell us what would have happened without any treatment at all.
Limitations
Small sample (22 enrolled, only 15 completed treatment), no control group, single center, some patients withdrew due to COVID-19, and this is Level III evidence testing an active laser treatment rather than observing untreated disease.
Taken word for word from the abstract
- population Patients ages 13-35 with moderate to severe disease who were referred for surgical excision were recruited.
- intervention Participants underwent 3-8 treatment sessions with the long-pulsed--Alexandrite (755 nm) laser by a dermatologist until hair removal endpoints were met.
- comparator A single-center prospective pilot study investigated laser hair removal as the primary treatment for moderate to severe pilonidal disease.
- primaryOutcome Primary outcomes included resolution rates without surgical intervention and recurrence rates following surgical resection.
- result Six of 15 (40 %) who completed laser treatments had resolution without surgical intervention. Nine patients underwent surgery, of which 6 (67 %) resolved after one surgery, with 18 months of follow up to evaluate for recurrence.
- n Twenty-two patients were enrolled, of which 18 were initiated and 15 completed the LHR sessions in the study
- followUp Patients were subsequently followed in the pediatric surgery clinic at 6, 9, 12 and 18 months following LHR to evaluate for disease recurrence.
J Pediatr Surg · PMID 39893840 · Read it on PubMed ↗
Andrew et al. 2025
Laser hair depilation therapy for pilonidal sinus disease: a 5-year, retrospective experience in a university teaching hospital in the UK, 2017-2023
Laser hair removal helped many heal without surgeryRetrospectiveLow qualityRelated question
97 people2025
more laser sessions was linked to symptom resolution; among patients who had no surgery, 78% improved or healed with laser treatment
Who was studied
patients referred for laser hair depilation for pilonidal sinus disease
What they received
laser hair depilation therapy
Compared with
patients who had surgery vs those who did not have surgery
Main outcome
whether the pilonidal sinus disease healed or improved
Quality
This was a retrospective review of medical records from one hospital with no untreated comparison group, so it cannot show what happens without any treatment at all.
Limitations
Retrospective single-center design; all patients received laser therapy so there is no true no-treatment control group; outcome assessment and disease staging were not standardized beyond clinical records.
Taken word for word from the abstract
- n extracted from electronic medical records of patients (n = 97) referred for laser hair depilation between 2017 and 2023
- population extracted from electronic medical records of patients (n = 97) referred for laser hair depilation between 2017 and 2023
- intervention Laser hair depilation is an established adjunct to surgical treatment for PSD.
- comparator Neither surgical intervention nor the type of surgery (incision, excision, modified flap, or endoscopic surgical intervention) showed a significant association with improvement in PSD (P = 0.47 and P = 0.65, respectively).
- primaryOutcome Treatment outcomes were categorized as improvement (healed, improved) or no improvement of underlying PSD.
- result The number of laser hair removal sessions was the only predictive factor for symptom resolution (P < 0.001).
- result In the subgroup of patients who did not undergo surgery (n = 32, 33%), 25 patients (78%) had improvement or healing in their PSD.
Clin Exp Dermatol · PMID 39815683 · Read it on PubMed ↗
Liang et al. 2024
Pilonidal disease in the pregnant patient: A case report
Cyst resolved twice without treatmentCase seriesVery low quality
1 peoplethrough pregnancy and postpartum period
symptoms came back once during pregnancy and went away on their own without treatment, then recurred again after birth and quickly resolved again, before she eventually had surgery
Who was studied
a 22-year-old pregnant woman with pilonidal disease
What they received
no treatment (watchful waiting) during pregnancy
Compared with
no comparator, single patient followed over time
Main outcome
whether symptoms went away without treatment
Quality
This is a single patient case report, so it cannot show how often this happens or whether it applies to other people.
Limitations
Only one patient; no control group; cannot generalize to others or determine cause.
Taken word for word from the abstract
- population An otherwise healthy primigravid 22-year-old woman developed pilonidal disease at the beginning of her pregnancy
- intervention She was managed non-operatively during pregnancy
- comparator Her symptoms recurred again in the postpartum period but they quickly resolved
- primaryOutcome her symptoms recurred once and resolved without treatment
- result While pregnant, her symptoms recurred once and resolved without treatment. She was managed non-operatively during pregnancy. Her symptoms recurred again in the postpartum period but they quickly resolved.
- n An otherwise healthy primigravid 22-year-old woman
Int J Surg Case Rep · PMID 38507939 · Read it on PubMed ↗
Adams et al. 2023
Regular epilation alone is an acceptable treatment for symptom-free pilonidal patients
Hair removal alone worked as well as surgery.Prospective cohortLow qualityRelated question
255 people612.5days (IQR:367.5-847)
recurrence was similar whether patients had surgery plus epilation (9.4%) or epilation alone (12.6%), with no significant difference
Who was studied
young patients with pilonidal disease, some symptom-free, treated at a pilonidal clinic
What they received
regular hair removal (epilation) alone for symptom-free patients
Compared with
surgical pit excision plus regular epilation
Main outcome
rate of disease recurrence
Quality
Patients were not randomly assigned to treatment (allocation changed based on calendar period), so differences in recurrence could be due to other factors.
Limitations
Non-randomized design with treatment assignment based on time period rather than random allocation, potential selection bias, and no comparison group that received no treatment at all.
Taken word for word from the abstract
- n 255 patients (male:54.4%, female:45.6%), median age 17.3years (IQR:15.8-19.1) were followed for median 612.5days
- population Patients with mild pilonidal disease often experience symptom resolution without excision.
- intervention symptom-free patients at presentation received only regular epilation
- comparator All patients presented before 12/2020 also underwent pit excision using trephines.
- primaryOutcome Recurrence rates were statistically analyzed.
- result The failure rate between patients who received surgical excision initially and recurred (9.4%) and patients who received epilation only and recurred (12.6%) was similar, after controlling for sex, race, age, comorbidities, skin type, hair color, hair thickness (p > 0.05).
- followUp followed for median 612.5days (IQR:367.5-847)
Pediatr Surg Int · PMID 37906293 · Read it on PubMed ↗

What actually helps, on this site

More about the condition:

Pilonidal Disease

All 15 studiesEvery study that answered the question, with its design, size and result.

The other 8 studiesEverything else the search returned, including anything retracted.

Öztaş et al. 2026
Artificial Intelligence-Based Prediction of Recurrence and Personalized Treatment Planning in Pediatric Pilonidal Sinus Disease
No data on spontaneous resolution.RetrospectiveLow qualityRelated question
242 people2026
recurrence rate was 5.7%, with no significant difference between treatment types
Who was studied
children with pilonidal sinus disease
What they received
surgical excision, crystallized phenol, or silver nitrate treatment
Compared with
different treatment types compared to each other
Main outcome
risk of the condition coming back after treatment
Quality
This is a retrospective study of treated patients only, with no group left untreated, so it cannot show whether the condition goes away on its own.
Limitations
Retrospective design, no untreated comparison group, and the study calls for further multicenter, prospective validation.
Taken word for word from the abstract
- n Clinical data from 242 pediatric PSD patients were retrospectively analyzed.
- population pediatric pilonidal sinus disease (PSD)
- intervention 59.1% underwent surgical excision (unroofing with secondary healing), 33.1% received crystallized phenol, and 7.8% were treated with silver nitrate
- comparator The overall recurrence rate was 5.7%, with no significant differences among treatment modalities.
- primaryOutcome predicting recurrence risk and supporting individualized treatment strategies in pediatric pilonidal sinus disease
- result The overall recurrence rate was 5.7%, with no significant differences among treatment modalities.
Surg Innov · PMID 41432023 · Read it on PubMed ↗
Chen et al. 2025
[Treatment options for different types of sacrococcygeal pilonidal disease]
Review of treatment options, not natural resolution.Narrative reviewLow qualityRelated question
size not given2025
the abstract summarizes which treatment approach fits each disease type but does not report whether cysts resolve without any treatment
Who was studied
patients with sacrococcygeal pilonidal disease (various types, including asymptomatic, acute abscess, recurrent, and extensive lesions)
What they received
different surgical and non-surgical treatment strategies for pilonidal disease
Compared with
different treatment approaches compared across disease presentations (no single comparator)
Main outcome
recurrence rate, recovery time, and complications across different treatment strategies
Quality
This is a narrative literature review based on clinical experience, not a study with data on natural resolution rates.
Limitations
No original data, sample size, or outcome statistics are given; it is a narrative summary of treatment strategies rather than a study of untreated disease course.
Taken word for word from the abstract
- population treatment strategies for different types of SPD
- intervention Non-surgical treatment is suitable for asymptomatic SPD patients.
- comparator Various surgical techniques have been employed for the treatment of SPD, but discrepancies and controversies persist in current clinical practice.
- primaryOutcome reduce recurrence rates, enable patients to quickly return to normal daily activities, and be associated with a low incidence of complications
- result this article summarizes the treatment strategies for different types of SPD, providing a reference for clinicians in formulating diagnosis and treatment plans
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 41397831 · Read it on PubMed ↗
Ekwesianya et al. 2025
Evaluating the Effectiveness of Gentamicin-Impregnated Collagen Sponge in the Prevention of Surgical Site Infection in Colorectal Surgery: A Systematic Literature Review and Meta-Analysis
No benefit for pilonidal surgery infectionMeta-analysisModerate qualityRelated question
2,233 people2025
the implant reduced infection in rectal surgery but had no significant effect in pilonidal disease surgery or its recurrence
Who was studied
patients having colorectal surgery, including some having pilonidal disease surgery
What they received
gentamicin-collagen implant placed at the surgical site
Compared with
surgery without the gentamicin-collagen implant
Main outcome
surgical site infection after surgery
Quality
it pools many randomised trials but the pilonidal-specific subgroup was small, giving an imprecise result.
Limitations
abstract does not report study-level details like blinding or follow-up duration; pilonidal subgroup analysis had wide confidence intervals
Taken word for word from the abstract
- n Fourteen RCTs with 2,233 patients (1,114 with and 1,119 without GCI) were analysed.
- population comparing GCI use with a defined control in colorectal surgeries
- intervention The application of Gentamicin-Collagen Implant (GCI) at a local surgical site
- comparator GCI use with a defined control in colorectal surgeries
- primaryOutcome Endpoints included incisional SSI, primary wound healing, and disease recurrence.
- result No significant effect was observed in pilonidal disease surgeries (RR = 0.34; CI = 0.09-1.23; p = 0.10) or its recurrence (RR = 0.62; CI = 0.09-4.57; p = 0.64).
Cureus · PMID 41328105 · Read it on PubMed ↗
O'Guinn et al. 2026
Pilonidal Disease
Doesn't say if it resolves aloneNarrative reviewLow qualityRelated question
size not given2026
the abstract does not state whether pilonidal cysts resolve without treatment; it describes management options and notes flap-based closures have lower recurrence but higher complication risk
Who was studied
adolescents and young adults with pilonidal disease
What they received
various treatments: non-operative management, incision and drainage, deroofing, marsupialization, primary closure, flap-based surgery
Compared with
different treatment approaches compared to each other
Main outcome
disease recurrence and complications
Quality
this is a narrative review describing treatment approaches without data on natural resolution without treatment, so it cannot answer whether cysts go away on their own.
Limitations
abstract does not report study design details, sample sizes, or specifically address spontaneous resolution of pilonidal cysts without intervention
Taken word for word from the abstract
- population Pilonidal disease, common in adolescents and young adults
- intervention Acute disease is primarily managed by incision and drainage; the addition of deroofing identified pits at the time of drainage can reduce recurrence.
- comparator Closures with flap-based techniques, such as Karydakis and Bascom's cleft lift, offer a lower recurrence rate but higher complication risks.
- primaryOutcome offer a lower recurrence rate but higher complication risks
- result Risk factors including obesity, sedentary lifestyle, and hirsutism should be addressed with initial non-operative management.
Surg Clin North Am · PMID 41241452 · Read it on PubMed ↗
Eyasu et al. 2025
Recurrent Umbilical Pilonidal Sinus: An Uncommon Condition Successfully Treated With Omphalectomy and Umbilicoplasty
Surgery fixed it; prior conservative care failed.Case seriesVery low qualityRelated question
1 peopleone year
Surgery successfully resolved the condition with no recurrence at one year, after conservative management had failed
Who was studied
33-year-old man with six years of smelly discharge from his belly button
What they received
Surgical removal of the cyst and sinus tracts (omphalectomy) with reconstructive umbilicoplasty
Compared with
Previous conservative treatment with antibiotics, hair removal, and hygiene measures
Main outcome
Resolution of the condition and cosmetic outcome after surgery
Quality
This is a single patient case report, which cannot show whether the condition would or would not resolve without treatment in general.
Limitations
Single case report; no control group; conservative management described was limited to antibiotics, hair removal, and hygiene rather than long-term watchful waiting.
Taken word for word from the abstract
- population a 33-year-old male with a six-year history of intermittent malodorous umbilical drainage
- intervention Complete excision of devitalized tissue was performed, followed by umbilicoplasty
- comparator Previous conservative management, including antibiotics, hair removal, and hygiene measures, failed to provide adequate relief
- primaryOutcome achieving a satisfactory cosmetic result based on patient-reported outcome
- result The patient recovered uneventfully with no recurrence at one year
- n the case of a 33-year-old male
Cureus · PMID 41181779 · Read it on PubMed ↗
Chakari et al. 2023
[Umbilical pilonidal sinus - a rare disease?]
Did not resolve without surgery.Case seriesVery low qualityRelated question
1 people6 months
no recurrence seen 6 months after surgery
Who was studied
young man with a hair-filled pit at the belly button (umbilical pilonidal sinus) that didn't improve with simple care
What they received
surgical removal of the sinus with stitching closed
Compared with
conservative treatment with hair removal and hygiene
Main outcome
whether the sinus came back after treatment
Quality
This is a report of just one patient, so it can't show what usually happens.
Limitations
Single case report, describes umbilical (belly button) location rather than the more common sacrococcygeal pilonidal cyst, short follow-up.
Taken word for word from the abstract
- population most often seen in adolescent male with a hairy abdomen
- intervention surgical excision and primary repair was indicated
- comparator Conservative treatment with hair extraction and personal hygiene is prioritized
- primaryOutcome No recurrence was observed 6 months postoperatively
- result No recurrence was observed 6 months postoperatively
- n Here one such case is presented
Lakartidningen · PMID 37818822 · Read it on PubMed ↗
Salih et al. 2023
Non-operative management of pilonidal sinus disease; classification and outcome
Abscess predicts recurrence risk.Prospective cohortLow qualityRelated question
3,529 people6 weeks
the most significant factor related to recurrence was the presence of an abscess, and patients were divided into three risk classes for recurrence
Who was studied
patients with sacrococcygeal pilonidal sinus disease, aged 14 to 55
What they received
non-surgical treatment using Salih's preparation (an antimicrobial and sclerosing agent)
Compared with
no comparison group; single-arm study
Main outcome
recurrence of pilonidal sinus 6 weeks after treatment
Quality
This was a single-arm study with no control group, short 6-week follow-up, and a large proportion of the original patients excluded without explanation.
Limitations
Only 3529 of 12123 treated patients were included, no comparison group, follow-up limited to 6 weeks, and overall success or resolution rate not reported.
Taken word for word from the abstract
- n of which only 3529 patients were included in this study
- population consecutive patients that had pilonidal sinus
- population The mean age of the participants was 26.95 years, ranging from 14 to 55 years.
- intervention All the patients were managed using Salih's preparation.
- comparator This is a single-group cohort study that enrolled consecutive patients that had pilonidal sinus.
- primaryOutcome The patients were seen at the clinic 6 weeks after the intervention to record data of recurrence.
- result The most significant factor related to the recurrence was the presence of an abscess.
- result accordingly, the patients were divided into three classes
Int Wound J · PMID 37259676 · Read it on PubMed ↗
Gil et al. 2023
Management of Pilonidal Disease: A Review
Reviews treatments, not natural resolution.Narrative reviewLow qualityRelated question
size not given2023
review found treatment evidence is limited and of poor quality, with no information on whether cysts resolve without treatment
Who was studied
people with pilonidal disease
What they received
various treatments for pilonidal disease, including conservative care, hair removal, injections, and surgery
Compared with
different treatment approaches compared with each other (no mention of no treatment or watchful waiting)
Main outcome
disease recurrence and treatment-related complications
Quality
this is a general narrative review of treatment options, not a study measuring whether cysts resolve on their own, and it says the underlying evidence is low quality.
Limitations
abstract states current evidence is limited by study quality with inconsistent definitions and outcome reporting across studies; does not address spontaneous resolution at all.
Taken word for word from the abstract
- population The management of pilonidal disease continues to be a challenge due to high rates of recurrence and treatment-associated morbidity.
- intervention There is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease and wide practice variation among clinicians.
- comparator Available treatment options vary considerably in their level of invasiveness, associated morbidity and disability, risks of complications, and effectiveness at preventing disease recurrence.
- primaryOutcome effectiveness at preventing disease recurrence
- result the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies
JAMA Surg · PMID 37256592 · Read it on PubMed ↗

How we searchedThe exact query, the date it ran, and what came back — so you can run it yourself.

Searched: PubMed · ClinicalTrials.gov · Crossref on 2026-10-13
The exact search — paste this into PubMed to repeat it: ("Pilonidal Sinus"[Mesh] OR pilonidal cyst[tiab] OR pilonidal disease[tiab]) AND (natural history[tiab] OR spontaneous resolution[tiab] OR "watchful waiting"[tiab] OR conservative management[tiab] OR self-resolv*[tiab] OR remission[tiab] OR recurrence[tiab]); PubMed expanded that to: ("Pilonidal Sinus"[MeSH Terms] OR "pilonidal cyst"[Title/Abstract] OR "pilonidal disease"[Title/Abstract]) AND ("natural history"[Title/Abstract] OR "spontaneous resolution"[Title/Abstract] OR "watchful waiting"[Title/Abstract] OR "conservative management"[Title/Abstract] OR "self resolv*"[Title/Abstract] OR "remission"[Title/Abstract] OR "recurrence"[Title/Abstract])
What came back: 849 records found · 198 read · 15 answered the question
Included: Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded: Records about a different condition or intervention
Records reporting no outcome
Retracted publications, which are listed but excluded from every count
Limits: Details were read from abstracts, not full papers, so anything reported only in a paper's methods section is not captured here.
Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.
Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.

849records came back from the search
198were read
15actually answered the question

Risks and safetyReported side effects and who should be careful.

In one large registry, about half of patients who did not have a procedure at first diagnosis were diagnosed with pilonidal disease again later, suggesting symptoms can return or persist if nothing is done, though this was not compared with a true no-treatment group.
Studies that classified disease by severity found that more advanced cysts had higher recurrence after treatment, which suggests delaying care could allow a cyst to become harder to resolve — though this was not directly tested.

Why people try thisThe reasoning behind the question — not a claim that it works.

The idea of avoiding surgery, with its pain, scarring, and recovery time, is appealing.
Embarrassment about the location can make people delay seeing a doctor and hope it resolves on its own.
Mild or intermittent symptoms can make it seem like the problem is already going away.
Cost or difficulty accessing surgical care makes a 'wait and see' approach feel like the only option.

Common questionsShort answers, drawn from the same studies.

Do pilonidal cysts go away?: Sometimes symptoms settle down on their own, as seen in one reported case, but there is no good study showing how common this is. Most of the research available looks at treatments, not at cysts left completely alone.
Can a pilonidal cyst go away on its own?: It's possible — one case report describes exactly this happening, twice, in the same person. But with only one documented case, no one can say how often this happens or who it happens to.
Will a pilonidal cyst go away by itself?: There's no reliable evidence to promise this. Some people may see symptoms ease temporarily, as in the one reported case, but it can also come back, and the cyst may still eventually need treatment.
How long does it take for a pilonidal cyst to go away?: No study has measured this. The single case report that describes spontaneous improvement doesn't give a clear timeline, so there's no evidence-based answer to how long it takes.
Should I just wait and not treat it?: The evidence doesn't support confidently waiting it out, since no trial has tested true watchful waiting against treatment. If symptoms worsen, spread, or you develop a painful swelling, that's a sign to see a doctor rather than wait.

This is information, not advice

This page summarises published research. It cannot tell you what is happening in your own body, and evidence changes. If something is bleeding, painful, or new, it is worth being looked at — that is a different question from the one on this page, and a better one to bring to a consultation.

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Automated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.

Allen Kamrava, MD, MBA, FACS, FASCRS · 435 N. Bedford Dr., Suite 308, Beverly Hills, CA 90210 · 424.279.8222

Educational information — not medical advice.