Can a pilonidal cyst go away on its own?
In patients with a pilonidal cyst/sinus, what proportion resolve spontaneously without drainage or surgery, and how long does spontaneous resolution take?
How people search for this, in their own words
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Evidence review in plain language · compiled 2026-10-14 · checked 2026-10-14 · next 2026-11-14 · automated review, how it works
What the evidence says
Bottom line
It's unclear — no study has tracked untreated pilonidal cysts to see if they heal on their own.
The three studies found don't test leaving a cyst completely alone. One followed children using conservative care like warm baths and hygiene (not no treatment at all) and found most healed. One case report describes a sinus that did not heal and persisted, untreated, for ten years. A third suggests the disease may settle down after age 30, but those patients had already been treated.
How well studied
Little evidence
The 3 human studies found measure a related question rather than this one, so they can only be read indirectly.
This question asks how a condition behaves over time, not whether a treatment works, so there is no benefit-or-harm verdict. What can be shown is how well it has been studied.
- answer it directly
- 0answer it directly
- studies found
- 3studies found
- randomised trials
- 0randomised trials
- people studied
- 72people studied
- years covered
- 1984–2018years covered
What the research shows
Spontaneous resolution rate
No study tracked people with a completely untreated cyst to see how many healed on their own. A study using conservative care (hygiene, hair removal, warm baths) in children found 79.3% of 29 children healed completely, but all received active care, so this doesn't show what happens with no care at all.[1]
Too little evidence
Time to resolution without intervention
One case report found a neglected sinus had still not healed after 10 years, but this is a single patient, not a measured average time to healing, and no study tracked healing time in untreated patients.[1]
Too little evidence
Recurrence after spontaneous resolution
No study followed people who healed without any treatment to see if the cyst came back. Recurrence (about 12%) has only been measured after people received conservative treatment, not after true spontaneous healing.[1]
Not studied
Progression to abscess requiring drainage
In one small study of children on conservative treatment, most healed but 4 of 29 still eventually needed surgery. This doesn't show how often a truly untreated cyst turns into an abscess.[1]
Too little evidence
Symptom duration (pain, drainage, swelling)
No study tracked day-to-day symptoms like pain or drainage in people left untreated. The one case report found drainage continued for years before a rare complication developed, but this is a single unusual case, not a typical timeline.[1]
Not studied
What the studies found
- In one small study, 79.3% of 29 children with pilonidal sinus disease healed completely using conservative care such as hygiene, hair removal, and warm baths rather than surgery.[1]
- A separate study suggested the disease may naturally settle down after age 30 for some patients, though these patients had already received treatment before being followed.[1]
Important limitations
- None of the three studies describes a group of patients who were simply left alone and observed. In the children's study (1), every patient received conservative treatment — hair removal, hygiene measures, warm sitz baths, and drainage for abscesses. The military hospital study (3) surveyed patients who had already received various treatments before answering the questionnaire. The case report (2) describes one person with recurrent abscesses and drainage over 10 years, but does not say whether he received any treatment during that time, before a cancer eventually developed at the site. None of these show what happens to a pilonidal sinus that is truly left untouched.[1,2,3]
- The studies are small (29, 1, and 42 people) and span decades (1984 to 2018), which limits how confidently the findings can be applied to any one person.[1,2,3]
- This was a small, retrospective study of 29 children, and it does not report how long or in what way patients were followed afterward, so recurrences or problems that happened later could have been missed.[1]
- The military hospital study relied on patients recalling their own history by questionnaire, which can be inaccurate, and most of those patients had already been treated before being followed.[1]
What kind of studies
- Retrospective2 · 67%
- Case series1 · 33%
The key studies
Cevik et al. 2018
Is conservative treatment an effective option for pilonidal sinus disease in children?
Mostly healed with simple careRetrospectiveLow qualityRelated question
29 people8.34 ± 6.36 (range: 1-25) months
79.3% of children healed completely with conservative treatment, 12% had recurrence, and 4 patients eventually needed surgery
- Who was studied
- children aged 12-16 with pilonidal sinus disease
- What they received
- conservative treatment (hair removal, hygiene, warm sitz baths, drainage for abscess)
- Main outcome
- complete healing and recurrence over time
- Quality
- this is a small retrospective review with phone follow-up and no untreated comparison group, so it can't show what happens without any treatment at all
- Limitations
- retrospective design, small sample, variable and sometimes short follow-up (1-25 months), telephone follow-up, and all patients received active conservative measures rather than being left untreated
Taken word for word from the abstract
- population
All children diagnosed with PSD in 2012 to 2017 were identified at the outpatient clinic of the Department of Paediatric Surgery.
- intervention
All patients initially underwent conservative treatment (meticulous hair removal, improved perianal hygiene, warm sitz baths, and drainage for abscess).
- primaryOutcome
Data collection included demographics, type of management, recurrence, presence of infection, and total healing time.
- result
Complete healing occurred in 79.3% of patients. Recurrence was evident in 12% of patients. Four patients underwent surgery.
- n
In the study period, 29 children were identified.
Int Wound J · PMID 29947121 · Read it on PubMed ↗
Eryılmaz et al. 2014
Recurrent squamous cell carcinoma arising in a neglected pilonidal sinus: report of a case and literature review
Did not resolve; worsened into cancer over years.Case seriesVery low qualityRelated question
1 peoplethe patient was followed for about 12 years in total (10 years before diagnosis, plus 2 years after treatment, after which he died)
Counted as a related question: This case report documents a rare complication (squamous cell carcinoma) that developed from a neglected pilonidal sinus, rather than describing the natural course or whether the cyst goes away on its own—it's about malignant transformation, not spontaneous resolution.
the sinus did not resolve on its own; it persisted for 10 years with repeated abscesses and drainage, and eventually developed into a cancerous mass (squamous cell carcinoma) at the site
- Who was studied
- a person with a long-standing, untreated pilonidal sinus in the lower back/tailbone area
- Main outcome
- what happens to a pilonidal sinus if left without proper treatment for many years
- Quality
- this is a single patient case report, so it cannot show what usually happens to pilonidal cysts and may not apply to most people.
- Limitations
- only one patient is described, there is no comparison group, and the case was selected because of its rare and severe outcome, which may not reflect typical disease course.
Taken word for word from the abstract
- n
A 44-year-old male
- population
A 44-year-old male, who is a heavy truck driver, applied to the hospital with chronic discharge from sacrococcygeal region.
- primaryOutcome
He had symptoms of the disease with multiple recurrent abscesses and spontaneous drainage for 10 years.
- result
He had symptoms of the disease with multiple recurrent abscesses and spontaneous drainage for 10 years.
- result
One year later, the patient was admitted to the hospital with a mass of 3 x 3 cm in the same area.
- result
This case study illustrates that since SCC is a fatal complication of recurrent and long-standing pilonidal sinus
Int J Clin Exp Med · PMID 24600504 · Read it on PubMed ↗
Clothier et al. 1984
The natural history of the post anal (pilonidal) sinus
May settle down naturally after age 30RetrospectiveLow qualityRelated question
42 people1984
The disease tends to be chronic with recurrences after treatment, but a natural regression point was suggested, usually after age 30, though a small group first develop the condition in their fourth decade
- Who was studied
- military hospital patients with pilonidal sinus disease (post anal sinus)
- Main outcome
- long-term recurrence and natural course of the sinus disease over time
- Quality
- Small retrospective questionnaire study of only 42 patients with recall-based data, so it cannot reliably show whether cysts resolve without treatment.
- Limitations
- Retrospective, questionnaire-based, small sample, and patients had already received various treatments rather than being followed untreated.
Taken word for word from the abstract
- n
Forty-two military hospital patients with post anal (pilonidal) sinus disease who had returned a questionnaire were studied retrospectively.
- population
Forty-two military hospital patients with post anal (pilonidal) sinus disease who had returned a questionnaire were studied retrospectively.
- primaryOutcome
Overall recurrence rate after various treatments was high, and it is suggested this be considered a chronic disease with a natural regression.
- result
it is suggested this be considered a chronic disease with a natural regression. Seldom this point seems to be after the 30th birthday. However, there appears to be a small group that develop the condition for the first time in their fourth decade.
Ann R Coll Surg Engl · PMID 6721409 · Read it on PubMed ↗
What actually helps, on this site
More about the condition:
All 3 studiesEvery study that answered the question, with its design, size and result.
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 2026-10-14
- The exact search — paste this into PubMed to repeat it
("Pilonidal Sinus"[Mesh] OR pilonidal cyst[tiab] OR pilonidal disease[tiab] OR pilonidal sinus[tiab]) AND (natural history[tiab] OR spontaneous resolution[tiab] OR self-resolving[tiab] OR watchful waiting[tiab] OR conservative management[tiab] OR untreated[tiab] OR disease course[tiab] OR remission[tiab])- PubMed expanded that to:
("Pilonidal Sinus"[MeSH Terms] OR "pilonidal cyst"[Title/Abstract] OR "pilonidal disease"[Title/Abstract] OR "Pilonidal Sinus"[Title/Abstract]) AND ("natural history"[Title/Abstract] OR "spontaneous resolution"[Title/Abstract] OR "self-resolving"[Title/Abstract] OR "watchful waiting"[Title/Abstract] OR "conservative management"[Title/Abstract] OR "untreated"[Title/Abstract] OR "disease course"[Title/Abstract] OR "remission"[Title/Abstract]) - What came back
- 36 records found · 36 read · 3 answered the question
- Included
- Human, animal or laboratory studies reporting an outcome relevant to the question
- Excluded
- Records about a different condition or intervention
- Studies mainly about Incision and drainage of abscess
- Studies mainly about Surgical excision (wide excision, flap procedures)
- Studies mainly about Minimally invasive sinus treatment (EPSiT, laser ablation)
- Studies mainly about Antibiotic-only treatment
- 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.
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.
- 36records came back from the search
- 36were read
- 3actually answered the question
Risks and safetyReported side effects and who should be careful.
- A case report describes a neglected, long-standing pilonidal sinus of 10 years that eventually developed into a cancer (squamous cell carcinoma) at the site. This is rare and based on a single patient, but it shows that leaving a long-standing sinus completely unaddressed is not without risk.
- In children treated conservatively, about 12% had the sinus return after it appeared to heal, and some still eventually needed surgery.
Why people askWhat brings people to this question.
- The cyst can shrink or stop draining for a while, which makes it seem like it has healed on its own.
- People want to avoid the pain, cost, or recovery time that comes with surgery.
- The area is embarrassing to discuss, so some people delay seeing a doctor and hope it resolves by itself.
- Early symptoms can be mild, which makes watching and waiting feel like a reasonable option.
Common questionsShort answers, drawn from the same studies.
- Do pilonidal cysts go away?
- Sometimes a cyst seems to settle down or stop draining, but no study has followed people who left a cyst completely untreated to see how often this happens or whether it lasts. The closest evidence comes from children using simple conservative care, not no care at all.
- Can a pilonidal cyst go away on its own?
- This hasn't been directly studied. One case report shows a neglected sinus can persist for years without going away, and it eventually led to a rare complication. That doesn't mean every cyst behaves this way, but it shows spontaneous healing isn't guaranteed.
- Will a pilonidal cyst go away by itself?
- No study has answered this directly. If you have an active cyst with pain, swelling, or drainage, it's reasonable to get it checked rather than wait, since the evidence on what happens with no care at all is lacking.
- How long does it take for a pilonidal cyst to go away?
- There's no reliable timeline from the studies, because none measured healing time in people who were left untreated. In one small study, children using conservative care like warm baths and hygiene were followed for varying lengths of time and most healed, but how long any single cyst takes isn't established.
- Should I just wait and see, or get it checked?
- Since there's no good evidence on what happens if a pilonidal cyst is left completely alone, and one case shows it can become a long-term problem, it's safer to have ongoing drainage, pain, or swelling evaluated by a clinician rather than wait indefinitely.
What has changedEvery re-check, and whether it changed the answer.
2026-10-14
Re-reviewed under a revised method: question type, study relevance and the harm rule. 3 new studies · 15 no longer retrieved · conclusion possible benefit → not applicable.
The conclusion changed.
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.
Contact the officeAutomated 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.