{ "slug": "do-pilonidal-cysts-go-away", "question": "Can a pilonidal cyst go away on its own?", "shortTitle": "Pilonidal Cyst: Does It Go Away on Its Own?", "clinicalQuestion": "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?", "pico": { "population": "Patients with a pilonidal cyst, abscess, or sinus (pilonidal disease) of the natal cleft", "intervention": "Watchful waiting or conservative (non-surgical) management, including observation, hygiene measures, or hair removal", "comparator": "Surgical treatment (incision and drainage, excision) or no intervention at all", "outcomes": [ "Spontaneous resolution rate", "Time to resolution of symptoms", "Recurrence rate after conservative management", "Rate of progression to abscess requiring drainage", "Need for eventual surgery", "Symptom-free interval duration" ] }, "category": "anorectal", "relatedConditions": [ "pilonidal-disease", "pilonidal-abscess", "pilonidal-sinus" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "A pilonidal cyst can sometimes settle down without surgery, but the evidence for this is extremely thin.", "detail": "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.", "studyIds": [ "pmid:38507939", "pmid:37906293", "pmid:39893840", "pmid:39815683" ] }, "strength": { "level": "very-low", "why": "The only direct evidence is 1 small or uncontrolled study.", "override": null }, "direction": { "level": "probable-benefit", "why": "The evidence points to a benefit, but it is not strong enough to be confident.", "override": null }, "counts": { "recordsRetrieved": 849, "recordsScreened": 198, "included": 15, "rcts": 0, "systematicReviews": 1, "observational": 8, "participants": 31900, "yearFrom": 2023, "yearTo": 2026, "registeredTrialsWithoutResults": 0 }, "excluded": [], "outcomes": [ { "name": "Spontaneous resolution rate (cyst goes away with no treatment at all)", "status": "insufficient", "note": "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.", "studyIds": [ "pmid:38507939" ] }, { "name": "Time to resolution of symptoms", "status": "not-studied", "note": "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.", "studyIds": [ "pmid:38507939" ] }, { "name": "Recurrence rate after conservative (non-surgical) management", "status": "possible-improvement", "note": "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.", "studyIds": [ "pmid:42020338", "pmid:37906293" ] }, { "name": "Progression to abscess requiring drainage", "status": "not-studied", "note": "No study measured how often an untreated cyst turns into a painful abscess that needs draining.", "studyIds": [] }, { "name": "Need for eventual surgery after trying non-surgical care", "status": "possible-improvement", "note": "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.", "studyIds": [ "pmid:39893840", "pmid:39815683" ] }, { "name": "Symptom-free interval duration", "status": "not-studied", "note": "No study reported how long symptom-free periods typically last without treatment.", "studyIds": [] } ], "benefits": [ { "text": "In one case report, a pregnant woman's pilonidal symptoms resolved on their own twice, without any treatment, though they returned each time.", "studyIds": [ "pmid:38507939" ] }, { "text": "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.", "studyIds": [ "pmid:37906293" ] } ], "limitations": [ { "text": "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.", "studyIds": [ "pmid:42020338", "pmid:41631611", "pmid:41432023", "pmid:40401769", "pmid:39893840", "pmid:39815683", "pmid:37906293", "pmid:37259676" ] }, { "text": "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.", "studyIds": [ "pmid:38507939" ] }, { "text": "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.", "studyIds": [ "pmid:39893840", "pmid:39815683", "pmid:37906293", "pmid:37259676" ] }, { "text": "Populations studied were often specific groups — children, military service members, or pregnant patients — which may not reflect the average adult asking this question.", "studyIds": [ "pmid:42020338", "pmid:41631611", "pmid:38507939" ] } ], "risks": [ { "text": "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.", "studyIds": [ "pmid:41631611" ], "severity": "minor" }, { "text": "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.", "studyIds": [ "pmid:40401769" ], "severity": "minor" } ], "whyPeopleTryIt": [ { "text": "The idea of avoiding surgery, with its pain, scarring, and recovery time, is appealing." }, { "text": "Embarrassment about the location can make people delay seeing a doctor and hope it resolves on its own." }, { "text": "Mild or intermittent symptoms can make it seem like the problem is already going away." }, { "text": "Cost or difficulty accessing surgical care makes a 'wait and see' approach feel like the only option." } ], "keyStudies": [ "pmid:38507939", "pmid:37906293", "pmid:39893840", "pmid:39815683", "pmid:42020338", "pmid:41631611", "pmid:40401769" ], "studies": [ { "id": "pmid:42020338", "pmid": "42020338", "doi": "10.1111/iwj.70907", "nctId": null, "pmcid": "PMC13102628", "title": "Minimally Invasive, Maximally Effective: Outpatient Strategies for Paediatric Pilonidal Disease", "firstAuthor": "Donnelly", "multipleAuthors": true, "journal": "Int Wound J", "year": 2026, "design": "retrospective", "n": 69, "nField": "reported", "population": "children and teenagers up to 18 years old with pilonidal sinus disease", "intervention": "structured outpatient care including conservative treatment and in-clinic debridement", "comparator": "operative treatment (trephination or limited excision)", "primaryOutcome": "recurrence after the wound had healed", "result": "recurrence happened in 26.1% of patients who had surgery versus 2.2% of patients managed without surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Conservative care had fewer recurrences than surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42020338/", "sourceText": "Pilonidal sinus disease (PNS) in children and adolescents lacks standardised management pathways. Minimally invasive and outpatient-based strategies are increasingly adopted, but paediatric-specific data remain limited. This study evaluated outcomes following implementation of a structured, tiered outpatient pathway. A retrospective single-centre cohort study was conducted including patients aged ≤ 18 years treated for PNS between February 2023 and August 2024. Management followed a stepwise protocol: structured conservative care, in-clinic debridement and operative intervention (trephination or limited excision) for refractory or severe disease. Primary outcome was recurrence after documented healing. Secondary outcomes included time to healing, clinic utilisation and associations with clinical variables. 69 patients were included (median age 15 years [IQR 14-16]; 64% male). Twenty-three patients (33.3%) required operative management. 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). Median follow-up duration did not differ significantly between groups. Prior infection at presentation showed a numerical but not statistically significant association with recurrence. Time to healing was prolonged in both groups and did not differ significantly. Within a structured outpatient pathway, paediatric patients demonstrated low overall recurrence rates. Conservative management was associated with lower recurrence; however, patients undergoing operative intervention likely represented a more severe subgroup. Prospective severity-adjusted studies are required to define optimal paediatric wound management strategies for PNS.", "provenance": [ { "field": "n", "quote": "69 patients were included" }, { "field": "population", "quote": "patients aged ≤ 18 years treated for PNS between February 2023 and August 2024" }, { "field": "intervention", "quote": "structured conservative care, in-clinic debridement" }, { "field": "comparator", "quote": "operative intervention (trephination or limited excision) for refractory or severe disease" }, { "field": "primaryOutcome", "quote": "Primary outcome was recurrence after documented healing" }, { "field": "result", "quote": "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)" } ] }, { "id": "pmid:41631611", "pmid": "41631611", "doi": "10.1093/milmed/usag015", "nctId": null, "pmcid": null, "title": "Pilonidal Disease: A Recent Decade of the Disease among Active Duty United States Military Service Members", "firstAuthor": "Griffiths", "multipleAuthors": true, "journal": "Mil Med", "year": 2026, "design": "registry", "n": 25039, "nField": "reported", "population": "active duty U.S. military service members diagnosed with pilonidal disease", "intervention": "no procedure performed at first diagnosis (watchful approach)", "comparator": "procedure performed at first diagnosis", "primaryOutcome": "healthcare utilization and disease recurrence/persistence patterns", "result": "About half of cases without initial surgery were still diagnosed again later, and surgery itself had a high repeat-diagnosis rate", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Abstract does not describe study design limitations beyond being a retrospective database review; no comparison group for natural resolution without any treatment.", "followUp": "", "plainFinding": "Many cysts persisted without surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41631611/", "sourceText": "INTRODUCTION: Sacrococcygeal pilonidal disease (PD) is a common surgical problem in the U.S. Military. Despite recent advancements, treatment strategies remain heterogenous and incompletely described, particularly among the active duty component in the Military Health System (MHS). This study's objectives were to identify the burden of PD and describe current healthcare utilization and treatment patterns in the MHS during a recent 10-year study period. MATERIALS AND METHODS: The study population included all active duty U.S. service members with at least one PD diagnosis in the MHS Data Repository between January 1, 2013, and December 31, 2022. For each patient, the first PD diagnosis during the study period was the incident case, and a subsequent case was defined as a second PD diagnosis >30 days after the first and categorized as recurrent (procedure performed at incident encounter) or persistent (no procedure performed at incident encounter). Procedures were identified by Current Procedural Terminology codes. RESULTS: During the study period, 25,039 active duty service members were diagnosed with an incident case of PD. The study population was mostly male, less than 30 years old, enlisted, and in the Army or Navy. The overall incidence rate was 1.7 per 1,000 person-years. Prevalence of recurrence was 44.6% (2,494 of 5,598) and persistence was 50.1% (9,731 of 19,441). Overall, there were 115,387 medical encounters with a PD diagnosis during the study period, and service members in the top 25% for healthcare utilization had ≥11 encounters with a PD diagnosis. CONCLUSIONS: Pilonidal disease imposes a significant burden on the MHS and is a threat to overall force medical readiness. Treatment strategies remain heterogeneous, and prospective studies are needed to refine clinical guidelines.", "provenance": [ { "field": "n", "quote": "25,039 active duty service members were diagnosed with an incident case of PD" }, { "field": "population", "quote": "active duty U.S. service members with at least one PD diagnosis in the MHS Data Repository" }, { "field": "intervention", "quote": "persistent (no procedure performed at incident encounter)" }, { "field": "comparator", "quote": "recurrent (procedure performed at incident encounter)" }, { "field": "primaryOutcome", "quote": "to identify the burden of PD and describe current healthcare utilization and treatment patterns in the MHS" }, { "field": "result", "quote": "Prevalence of recurrence was 44.6% (2,494 of 5,598) and persistence was 50.1% (9,731 of 19,441)." } ] }, { "id": "pmid:41432023", "pmid": "41432023", "doi": "10.1177/15533506251411009", "nctId": null, "pmcid": null, "title": "Artificial Intelligence-Based Prediction of Recurrence and Personalized Treatment Planning in Pediatric Pilonidal Sinus Disease", "firstAuthor": "Öztaş", "multipleAuthors": true, "journal": "Surg Innov", "year": 2026, "design": "retrospective", "n": 242, "nField": "reported", "population": "children with pilonidal sinus disease", "intervention": "surgical excision, crystallized phenol, or silver nitrate treatment", "comparator": "different treatment types compared to each other", "primaryOutcome": "risk of the condition coming back after treatment", "result": "recurrence rate was 5.7%, with no significant difference between treatment types", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, no untreated comparison group, and the study calls for further multicenter, prospective validation.", "followUp": "", "plainFinding": "No data on spontaneous resolution.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41432023/", "sourceText": "PurposeThis study aimed to assess the feasibility of artificial intelligence (AI)-based models for predicting recurrence risk and supporting individualized treatment strategies in pediatric pilonidal sinus disease (PSD).MethodsClinical data from 242 pediatric PSD patients were retrospectively analyzed. Two machine learning (ML) models were developed: (1) a binary classifier for recurrence prediction and (2) a multiclass classifier for treatment modality selection. Model performance was evaluated using 5-fold cross-validation based on accuracy, area under the receiver operating characteristic curve (ROC-AUC), F1 score, and confusion matrix. Model interpretability was assessed using SHapley Additive exPlanations (SHAP) analysis to identify the most influential predictive features.ResultsAmong 242 patients, 59.1% underwent surgical excision (unroofing with secondary healing), 33.1% received crystallized phenol, and 7.8% were treated with silver nitrate. The overall recurrence rate was 5.7%, with no significant differences among treatment modalities. Longer healing duration, larger lesion size, higher body mass index (BMI), and an increased number of sinus tracts were associated with higher recurrence risk. SHAP analysis revealed that healing time, BMI, age, and the number of sinus tracts were the most influential predictors in both recurrence and treatment selection models.ConclusionAI-based predictive models can effectively estimate recurrence risk and assist in tailoring individualized management strategies for pediatric PSD. Further multicenter, prospective studies are warranted to validate these findings and support clinical integration of AI-assisted decision systems.", "provenance": [ { "field": "n", "quote": "Clinical data from 242 pediatric PSD patients were retrospectively analyzed." }, { "field": "population", "quote": "pediatric pilonidal sinus disease (PSD)" }, { "field": "intervention", "quote": "59.1% underwent surgical excision (unroofing with secondary healing), 33.1% received crystallized phenol, and 7.8% were treated with silver nitrate" }, { "field": "comparator", "quote": "The overall recurrence rate was 5.7%, with no significant differences among treatment modalities." }, { "field": "primaryOutcome", "quote": "predicting recurrence risk and supporting individualized treatment strategies in pediatric pilonidal sinus disease" }, { "field": "result", "quote": "The overall recurrence rate was 5.7%, with no significant differences among treatment modalities." } ] }, { "id": "pmid:41397831", "pmid": "41397831", "doi": "10.3760/cma.j.cn441530-20251104-00417", "nctId": null, "pmcid": null, "title": "[Treatment options for different types of sacrococcygeal pilonidal disease]", "firstAuthor": "Chen", "multipleAuthors": true, "journal": "Zhonghua Wei Chang Wai Ke Za Zhi", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "patients with sacrococcygeal pilonidal disease (various types, including asymptomatic, acute abscess, recurrent, and extensive lesions)", "intervention": "different surgical and non-surgical treatment strategies for pilonidal disease", "comparator": "different treatment approaches compared across disease presentations (no single comparator)", "primaryOutcome": "recurrence rate, recovery time, and complications across different treatment strategies", "result": "the abstract summarizes which treatment approach fits each disease type but does not report whether cysts resolve without any treatment", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a narrative literature review based on clinical experience, not a study with data on natural resolution rates.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Review of treatment options, not natural resolution.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41397831/", "sourceText": "The treatment of sacrococcygeal pilonidal disease (SPD) remains challenging due to its high recurrence rate and treatment-related complications. An ideal treatment plan for SPD should be simple to perform, reduce recurrence rates, enable patients to quickly return to normal daily activities, and be associated with a low incidence of complications. Various surgical techniques have been employed for the treatment of SPD, but discrepancies and controversies persist in current clinical practice. Non-surgical treatment is suitable for asymptomatic SPD patients. For patients in the acute abscess phase, drainage is the primary therapeutic goal, with avoidance of midline incisions. Minimally invasive procedures may be considered for patients with localized lesions after weighing the recurrence risk, aiming for faster recovery and better cosmetic outcomes. For recurrent SPD or cases with extensive lesions, excision followed by secondary healing or combined with flap techniques is required to pursue a lower recurrence risk. Based on clinical experience and literature review, this article summarizes the treatment strategies for different types of SPD, providing a reference for clinicians in formulating diagnosis and treatment plans.", "provenance": [ { "field": "population", "quote": "treatment strategies for different types of SPD" }, { "field": "intervention", "quote": "Non-surgical treatment is suitable for asymptomatic SPD patients." }, { "field": "comparator", "quote": "Various surgical techniques have been employed for the treatment of SPD, but discrepancies and controversies persist in current clinical practice." }, { "field": "primaryOutcome", "quote": "reduce recurrence rates, enable patients to quickly return to normal daily activities, and be associated with a low incidence of complications" }, { "field": "result", "quote": "this article summarizes the treatment strategies for different types of SPD, providing a reference for clinicians in formulating diagnosis and treatment plans" } ] }, { "id": "pmid:41328105", "pmid": "41328105", "doi": "10.7759/cureus.95798", "nctId": null, "pmcid": "PMC12665139", "title": "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", "firstAuthor": "Ekwesianya", "multipleAuthors": true, "journal": "Cureus", "year": 2025, "design": "meta-analysis", "n": 2233, "nField": "reported", "population": "patients having colorectal surgery, including some having pilonidal disease surgery", "intervention": "gentamicin-collagen implant placed at the surgical site", "comparator": "surgery without the gentamicin-collagen implant", "primaryOutcome": "surgical site infection after surgery", "result": "the implant reduced infection in rectal surgery but had no significant effect in pilonidal disease surgery or its recurrence", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it pools many randomised trials but the pilonidal-specific subgroup was small, giving an imprecise result.", "directness": "indirect", "limitations": "abstract does not report study-level details like blinding or follow-up duration; pilonidal subgroup analysis had wide confidence intervals", "followUp": "", "plainFinding": "No benefit for pilonidal surgery infection", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41328105/", "sourceText": "Surgical site infection (SSI) is a frequent postoperative complication, particularly in colorectal surgeries, which exhibit higher SSI rates than other procedures. The application of Gentamicin-Collagen Implant (GCI) at a local surgical site maximises not only the unique qualities of collagen in enhancing wound healing but also the antibacterial effects of gentamicin. The objective of this study is to determine if SSI is reduced by the use of GCI during colorectal procedures. Included studies were randomised controlled trials (RCTs) comparing GCI use with a defined control in colorectal surgeries. Exclusions comprised non-RCTs, case reports, animal studies, non-colorectal surgery comparisons, and studies lacking relevant endpoints. Literature searches were conducted in January 2025 using the SCOPUS, PubMed, Embase, and Cochrane Library medical databases. Risk of bias was assessed with the Rob2 tool (Cochrane Collaboration, Oxford, UK), and a meta-analysis was conducted using Review Manager (Cochrane Collaboration). Endpoints included incisional SSI, primary wound healing, and disease recurrence. Fourteen RCTs with 2,233 patients (1,114 with and 1,119 without GCI) were analysed. GCI significantly lowered overall SSI incidence (RR = 0.54; CI = 0.35-0.85; p = 0.007) and specifically in rectal surgeries (RR = 0.56; CI = 0.39-0.81; p = 0.002). 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). GCI effectively reduces SSI in rectal surgeries but not in pilonidal disease operations. Routine GCI may reduce SSI in rectal surgery.", "provenance": [ { "field": "n", "quote": "Fourteen RCTs with 2,233 patients (1,114 with and 1,119 without GCI) were analysed." }, { "field": "population", "quote": "comparing GCI use with a defined control in colorectal surgeries" }, { "field": "intervention", "quote": "The application of Gentamicin-Collagen Implant (GCI) at a local surgical site" }, { "field": "comparator", "quote": "GCI use with a defined control in colorectal surgeries" }, { "field": "primaryOutcome", "quote": "Endpoints included incisional SSI, primary wound healing, and disease recurrence." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:41241452", "pmid": "41241452", "doi": "10.1016/j.suc.2025.08.005", "nctId": null, "pmcid": null, "title": "Pilonidal Disease", "firstAuthor": "O'Guinn", "multipleAuthors": true, "journal": "Surg Clin North Am", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "adolescents and young adults with pilonidal disease", "intervention": "various treatments: non-operative management, incision and drainage, deroofing, marsupialization, primary closure, flap-based surgery", "comparator": "different treatment approaches compared to each other", "primaryOutcome": "disease recurrence and complications", "result": "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", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "abstract does not report study design details, sample sizes, or specifically address spontaneous resolution of pilonidal cysts without intervention", "followUp": "", "plainFinding": "Doesn't say if it resolves alone", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41241452/", "sourceText": "Pilonidal disease, common in adolescents and young adults, is linked to hair insertion, friction, and bacterial colonization. Risk factors including obesity, sedentary lifestyle, and hirsutism should be addressed with initial non-operative management. Acute disease is primarily managed by incision and drainage; the addition of deroofing identified pits at the time of drainage can reduce recurrence. Management of chronic pilonidal disease is focused on removal of pits with the possible addition of marsupialization or primary closure. Closures with flap-based techniques, such as Karydakis and Bascom's cleft lift, offer a lower recurrence rate but higher complication risks.", "provenance": [ { "field": "population", "quote": "Pilonidal disease, common in adolescents and young adults" }, { "field": "intervention", "quote": "Acute disease is primarily managed by incision and drainage; the addition of deroofing identified pits at the time of drainage can reduce recurrence." }, { "field": "comparator", "quote": "Closures with flap-based techniques, such as Karydakis and Bascom's cleft lift, offer a lower recurrence rate but higher complication risks." }, { "field": "primaryOutcome", "quote": "offer a lower recurrence rate but higher complication risks" }, { "field": "result", "quote": "Risk factors including obesity, sedentary lifestyle, and hirsutism should be addressed with initial non-operative management." } ] }, { "id": "pmid:41181779", "pmid": "41181779", "doi": "10.7759/cureus.93714", "nctId": null, "pmcid": "PMC12579483", "title": "Recurrent Umbilical Pilonidal Sinus: An Uncommon Condition Successfully Treated With Omphalectomy and Umbilicoplasty", "firstAuthor": "Eyasu", "multipleAuthors": true, "journal": "Cureus", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "33-year-old man with six years of smelly discharge from his belly button", "intervention": "Surgical removal of the cyst and sinus tracts (omphalectomy) with reconstructive umbilicoplasty", "comparator": "Previous conservative treatment with antibiotics, hair removal, and hygiene measures", "primaryOutcome": "Resolution of the condition and cosmetic outcome after surgery", "result": "Surgery successfully resolved the condition with no recurrence at one year, after conservative management had failed", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, which cannot show whether the condition would or would not resolve without treatment in general.", "directness": "indirect", "limitations": "Single case report; no control group; conservative management described was limited to antibiotics, hair removal, and hygiene rather than long-term watchful waiting.", "followUp": "one year", "plainFinding": "Surgery fixed it; prior conservative care failed.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41181779/", "sourceText": "Umbilical pilonidal sinus is a rare subtype of chronic pilonidal disease, which more commonly affects the sacrococcygeal region. Diagnosis is often delayed due to low clinical suspicion and overlapping presentations with more common abdominal wall conditions. We report the case of a 33-year-old male with a six-year history of intermittent malodorous umbilical drainage causing significant psychosocial distress. Previous conservative management, including antibiotics, hair removal, and hygiene measures, failed to provide adequate relief. Imaging, both ultrasound and computed tomography (CT), was unremarkable apart from only mild umbilical inflammation. Operative exploration revealed a nest of hair and sinus tracts terminating in a cyst at the umbilical base. Complete excision of devitalized tissue was performed, followed by umbilicoplasty, achieving a satisfactory cosmetic result based on patient-reported outcome. The patient recovered uneventfully with no recurrence at one year. Umbilical pilonidal sinus, though rare (~0.6% of pilonidal disease cases), should be considered in patients with chronic umbilical discharge. Surgical excision with umbilicoplasty offers definitive management and reliable long-term results.", "provenance": [ { "field": "population", "quote": "a 33-year-old male with a six-year history of intermittent malodorous umbilical drainage" }, { "field": "intervention", "quote": "Complete excision of devitalized tissue was performed, followed by umbilicoplasty" }, { "field": "comparator", "quote": "Previous conservative management, including antibiotics, hair removal, and hygiene measures, failed to provide adequate relief" }, { "field": "primaryOutcome", "quote": "achieving a satisfactory cosmetic result based on patient-reported outcome" }, { "field": "result", "quote": "The patient recovered uneventfully with no recurrence at one year" }, { "field": "n", "quote": "the case of a 33-year-old male" } ] }, { "id": "pmid:40401769", "pmid": "40401769", "doi": "10.1097/XCS.0000000000001454", "nctId": null, "pmcid": null, "title": "Standardized Classification System for Pilonidal Disease and Recurrence Rate after Treatment", "firstAuthor": "Chiu", "multipleAuthors": true, "journal": "J Am Coll Surg", "year": 2025, "design": "prospective-cohort", "n": 411, "nField": "reported", "population": "patients presenting with pilonidal disease at a specialized pilonidal care center", "intervention": "being classified at a higher pilonidal disease severity (PDS) stage at initial presentation", "comparator": "lower PDS stages (0, I, II) at initial presentation", "primaryOutcome": "pilonidal disease recurrence at 1- and 2-year follow-up", "result": "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%", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "limitations": "Only 212 of 411 patients completed 1-year follow-up and 206 completed 2-year follow-up; single specialized center.", "followUp": "1- and 2-year follow-up", "plainFinding": "Higher-stage disease recurs more after treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40401769/", "sourceText": "BACKGROUND: Current classification systems for pilonidal disease do not objectively profile disease severity, limiting their clinical applicability. This study aimed to validate a novel pilonidal disease severity (PDS) staging system by testing its correlation with disease recurrence. STUDY DESIGN: This was a prospective cohort study set at a high-volume, specialized pilonidal care center. All patients presenting with pilonidal disease were included. The main effector under study was PDS stage assigned at initial presentation. Secondary effector variables were an open wound greater than 1 cm on presentation (descriptor W) or previous surgical resection (descriptor R). The primary outcome was pilonidal disease recurrence at 1- and 2-year follow-up. RESULTS: A total of 411 patients met criteria, with 212 and 206 patients completing 1- and 2-year follow-up, respectively. Among patients who completed 1-year follow-up, 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). The presence of an open wound at initial presentation and previous surgical resection was not associated with risk of recurrence (W, p = 0.94; R, p = 0.98). CONCLUSIONS: This study described the first staging system for pilonidal disease that correlates with risk of recurrence. On further external validation, the PDS staging system may be used both clinically to tailor treatment regimens to risk of disease recurrence and in research to standardize disease severity when comparing different therapeutic interventions.", "provenance": [ { "field": "n", "quote": "A total of 411 patients met criteria, with 212 and 206 patients completing 1- and 2-year follow-up, respectively." }, { "field": "population", "quote": "All patients presenting with pilonidal disease were included." }, { "field": "intervention", "quote": "The main effector under study was PDS stage assigned at initial presentation." }, { "field": "comparator", "quote": "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" }, { "field": "primaryOutcome", "quote": "The primary outcome was pilonidal disease recurrence at 1- and 2-year follow-up." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:39893840", "pmid": "39893840", "doi": "10.1016/j.jpedsurg.2025.162182", "nctId": null, "pmcid": "PMC11993338", "title": "Laser Hair Removal May Be a Primary Treatment of Pilonidal Disease: A Pilot Study", "firstAuthor": "Janek", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2025, "design": "prospective-cohort", "n": 22, "nField": "reported", "population": "teens and young adults ages 13-35 with moderate to severe pilonidal disease who were going to need surgery", "intervention": "laser hair removal using an Alexandrite laser, given before surgery was tried", "comparator": "no comparison group; outcomes tracked over time in the same patients", "primaryOutcome": "whether the disease went away without surgery, and whether it came back after surgery", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "18 months", "plainFinding": "Laser hair removal, not no treatment, helped some patients avoid surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39893840/", "sourceText": "INTRODUCTION: Pilonidal disease is a chronic skin disorder of the gluteal cleft in adolescents and young adults. No treatment is universally effective, and the heterogeneity of the disease and variability in treatment response frustrates patients and clinicians alike. Surgical treatment strategies focus on the removal of the sinus tracts. Post-operative laser hair removal (LHR) has demonstrated promise to reduce disease recurrence following surgery. LHR has yet to be investigated as a primary treatment strategy and may offer additional benefits. METHODS: A single-center prospective pilot study investigated laser hair removal as the primary treatment for moderate to severe pilonidal disease. Patients ages 13-35 with moderate to severe disease who were referred for surgical excision were recruited. Participants underwent 3-8 treatment sessions with the long-pulsed--Alexandrite (755 nm) laser by a dermatologist until hair removal endpoints were met. Patients with persistent symptoms after LHR underwent subsequent excision. Patients were subsequently followed in the pediatric surgery clinic at 6, 9, 12 and 18 months following LHR to evaluate for disease recurrence. Primary outcomes included resolution rates without surgical intervention and recurrence rates following surgical resection. Secondary outcomes included the number of episodes of infection and impact on quality of life, as assessed by the Dermatology Life Quality Index (DLQI) in patients ≥16 years of age, and the Children's Dermatology Life Quality Index (CDLQI) in patients <16 years of age. RESULTS: Twenty-two patients were enrolled, of which 18 were initiated and 15 completed the LHR sessions in the study, designed to the endpoint of the absence of terminal hair in the gluteal cleft. One patient withdrew prior to completion of the LHR sessions, and two withdrew from the study due to the COVID-19 pandemic. Of the 15 patients who completed the LHR sessions, all demonstrated significant improvement in hair follicle density in the treatment area, with no adverse events. Median number of laser treatments was 6. 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. Quality of life scores improved after laser treatments (DLQI mean change -4.6, and Children's DLQI mean change -6.0) CONCLUSION: Laser hair removal was well tolerated, without adverse events and with improved quality of life, in a patient population with moderate to severe pilonidal disease. Nearly half of patients had disease resolution without the need for surgical intervention. These findings underscore the potential for laser hair removal to improve disease outcomes in pilonidal disease, reducing the need for surgical intervention. Based on these results, laser hair removal might provide an effective primary treatment strategy for some patients, and could improve outcomes for those who require surgical intervention. Further research is needed to determine which patients would most likely benefit from this treatment strategy. LEVEL OF EVIDENCE: Level III.", "provenance": [ { "field": "population", "quote": "Patients ages 13-35 with moderate to severe disease who were referred for surgical excision were recruited." }, { "field": "intervention", "quote": "Participants underwent 3-8 treatment sessions with the long-pulsed--Alexandrite (755 nm) laser by a dermatologist until hair removal endpoints were met." }, { "field": "comparator", "quote": "A single-center prospective pilot study investigated laser hair removal as the primary treatment for moderate to severe pilonidal disease." }, { "field": "primaryOutcome", "quote": "Primary outcomes included resolution rates without surgical intervention and recurrence rates following surgical resection." }, { "field": "result", "quote": "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." }, { "field": "n", "quote": "Twenty-two patients were enrolled, of which 18 were initiated and 15 completed the LHR sessions in the study" }, { "field": "followUp", "quote": "Patients were subsequently followed in the pediatric surgery clinic at 6, 9, 12 and 18 months following LHR to evaluate for disease recurrence." } ] }, { "id": "pmid:39815683", "pmid": "39815683", "doi": "10.1093/ced/llaf035", "nctId": null, "pmcid": null, "title": "Laser hair depilation therapy for pilonidal sinus disease: a 5-year, retrospective experience in a university teaching hospital in the UK, 2017-2023", "firstAuthor": "Andrew", "multipleAuthors": true, "journal": "Clin Exp Dermatol", "year": 2025, "design": "retrospective", "n": 97, "nField": "reported", "population": "patients referred for laser hair depilation for pilonidal sinus disease", "intervention": "laser hair depilation therapy", "comparator": "patients who had surgery vs those who did not have surgery", "primaryOutcome": "whether the pilonidal sinus disease healed or improved", "result": "more laser sessions was linked to symptom resolution; among patients who had no surgery, 78% improved or healed with laser treatment", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Laser hair removal helped many heal without surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39815683/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a chronic, debilitating condition predominantly affecting young men. Laser hair depilation is an established adjunct to surgical treatment for PSD. It can lead to reduced rates of recurrence and postsurgical interventions. OBJECTIVES: To assess the outcome of laser hair depilation therapy on disease progression in patients with PSD at the Birmingham Skin Regional Laser Centre. METHODS: Patient demographics, PSD clinical stage, laser type, number of laser sessions, surgical intervention and treatment outcomes were extracted from electronic medical records of patients (n = 97) referred for laser hair depilation between 2017 and 2023. Statistical analysis was performed using Microsoft Excel and R. Treatment outcomes were categorized as improvement (healed, improved) or no improvement of underlying PSD. Disease severity was classified using the method of Guner et al. (BMC Surg 2016; 16:18). RESULTS: Most patients affected were male (77%). The median age was 22 years (interquartile range 20-28). The median number of laser hair removal sessions was 8 (interquartile range 5.5-10). The number of laser hair removal sessions was the only predictive factor for symptom resolution (P < 0.001). 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). In the subgroup of patients who did not undergo surgery (n = 32, 33%), 25 patients (78%) had improvement or healing in their PSD. There were no statistically significant associations between age, type of laser, disease severity and benefit from laser hair removal. No complications were reported and there was only one case of recurrence. CONCLUSIONS: Laser hair depilation is a safe and effective postoperative adjunct treatment for treating sacrococcygeal PSD. For early-stage disease it may offer curative treatment.", "provenance": [ { "field": "n", "quote": "extracted from electronic medical records of patients (n = 97) referred for laser hair depilation between 2017 and 2023" }, { "field": "population", "quote": "extracted from electronic medical records of patients (n = 97) referred for laser hair depilation between 2017 and 2023" }, { "field": "intervention", "quote": "Laser hair depilation is an established adjunct to surgical treatment for PSD." }, { "field": "comparator", "quote": "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)." }, { "field": "primaryOutcome", "quote": "Treatment outcomes were categorized as improvement (healed, improved) or no improvement of underlying PSD." }, { "field": "result", "quote": "The number of laser hair removal sessions was the only predictive factor for symptom resolution (P < 0.001)." }, { "field": "result", "quote": "In the subgroup of patients who did not undergo surgery (n = 32, 33%), 25 patients (78%) had improvement or healing in their PSD." } ] }, { "id": "pmid:38507939", "pmid": "38507939", "doi": "10.1016/j.ijscr.2024.109539", "nctId": null, "pmcid": "PMC10963643", "title": "Pilonidal disease in the pregnant patient: A case report", "firstAuthor": "Liang", "multipleAuthors": true, "journal": "Int J Surg Case Rep", "year": 2024, "design": "case-series", "n": 1, "nField": "reported", "population": "a 22-year-old pregnant woman with pilonidal disease", "intervention": "no treatment (watchful waiting) during pregnancy", "comparator": "no comparator, single patient followed over time", "primaryOutcome": "whether symptoms went away without treatment", "result": "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", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how often this happens or whether it applies to other people.", "directness": "direct", "limitations": "Only one patient; no control group; cannot generalize to others or determine cause.", "followUp": "through pregnancy and postpartum period", "plainFinding": "Cyst resolved twice without treatment", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38507939/", "sourceText": "INTRODUCTION: Pilonidal disease in the pregnant patient is underreported and may be instigated by significant shifts in hormone levels throughout pregnancy and the postpartum period. PRESENTATION OF CASE: An otherwise healthy primigravid 22-year-old woman developed pilonidal disease at the beginning of her pregnancy. 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. Due to the recurrent symptoms, she underwent definitive management via minimally invasive Gips procedure in the postpartum period, without further recurrence. DISCUSSION: Pilonidal disease affects pregnant patients and can be managed non-operatively. The etiology of pilonidal disease in the setting of pregnancy may be related to hormonal shifts and warrants further investigation. CONCLUSION: We present the first report of pilonidal disease in a pregnant patient in the primary literature. The hormonal shifts associated with pregnancy may be associated with the development of pilonidal disease in the pregnant patient.", "provenance": [ { "field": "population", "quote": "An otherwise healthy primigravid 22-year-old woman developed pilonidal disease at the beginning of her pregnancy" }, { "field": "intervention", "quote": "She was managed non-operatively during pregnancy" }, { "field": "comparator", "quote": "Her symptoms recurred again in the postpartum period but they quickly resolved" }, { "field": "primaryOutcome", "quote": "her symptoms recurred once and resolved without treatment" }, { "field": "result", "quote": "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." }, { "field": "n", "quote": "An otherwise healthy primigravid 22-year-old woman" } ] }, { "id": "pmid:37906293", "pmid": "37906293", "doi": "10.1007/s00383-023-05577-w", "nctId": null, "pmcid": null, "title": "Regular epilation alone is an acceptable treatment for symptom-free pilonidal patients", "firstAuthor": "Adams", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2023, "design": "prospective-cohort", "n": 255, "nField": "reported", "population": "young patients with pilonidal disease, some symptom-free, treated at a pilonidal clinic", "intervention": "regular hair removal (epilation) alone for symptom-free patients", "comparator": "surgical pit excision plus regular epilation", "primaryOutcome": "rate of disease recurrence", "result": "recurrence was similar whether patients had surgery plus epilation (9.4%) or epilation alone (12.6%), with no significant difference", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "Patients were not randomly assigned to treatment (allocation changed based on calendar period), so differences in recurrence could be due to other factors.", "directness": "indirect", "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.", "followUp": "612.5days (IQR:367.5-847)", "plainFinding": "Hair removal alone worked as well as surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37906293/", "sourceText": "INTRODUCTION: Patients with mild pilonidal disease often experience symptom resolution without excision. We hypothesized that treating symptom-free/asymptomatic pilonidal patients with regular epilation alone had similar recurrence rate as patients who were also treated surgically. METHOD: Patient data were prospectively collected 2/2019-11/2022 at our Pilonidal Clinic. All patients received regular epilation; all patients presented before 12/2020 also underwent pit excision using trephines. Starting 1/2021, only symptomatic patients underwent pit excision; symptom-free patients at presentation received only regular epilation. Recurrence rates were statistically analyzed. RESULTS: 255 patients (male:54.4%, female:45.6%), median age 17.3years (IQR:15.8-19.1) were followed for median 612.5days (IQR:367.5-847). 44.1% identified as Hispanic, 36.5% Caucasian, 17.1% Asian, 2.4% Black. Median symptom duration at presentation was 180.5days (IQR:44.5-542.5). 160 patients were initially treated with surgical excision and regular epilation, while 95 patients with regular epilation only. 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). Patients who recurred after only undergoing regular epilation all underwent surgical excision, median 100days (IQR:59.5-123.5) after initial presentation. CONCLUSION: Regular epilation alone is an acceptable treatment for symptom-free pilonidal patients.", "provenance": [ { "field": "n", "quote": "255 patients (male:54.4%, female:45.6%), median age 17.3years (IQR:15.8-19.1) were followed for median 612.5days" }, { "field": "population", "quote": "Patients with mild pilonidal disease often experience symptom resolution without excision." }, { "field": "intervention", "quote": "symptom-free patients at presentation received only regular epilation" }, { "field": "comparator", "quote": "All patients presented before 12/2020 also underwent pit excision using trephines." }, { "field": "primaryOutcome", "quote": "Recurrence rates were statistically analyzed." }, { "field": "result", "quote": "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)." }, { "field": "followUp", "quote": "followed for median 612.5days (IQR:367.5-847)" } ] }, { "id": "pmid:37818822", "pmid": "37818822", "doi": null, "nctId": null, "pmcid": null, "title": "[Umbilical pilonidal sinus - a rare disease?]", "firstAuthor": "Chakari", "multipleAuthors": true, "journal": "Lakartidningen", "year": 2023, "design": "case-series", "n": 1, "nField": "reported", "population": "young man with a hair-filled pit at the belly button (umbilical pilonidal sinus) that didn't improve with simple care", "intervention": "surgical removal of the sinus with stitching closed", "comparator": "conservative treatment with hair removal and hygiene", "primaryOutcome": "whether the sinus came back after treatment", "result": "no recurrence seen 6 months after surgery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a report of just one patient, so it can't show what usually happens.", "directness": "indirect", "limitations": "Single case report, describes umbilical (belly button) location rather than the more common sacrococcygeal pilonidal cyst, short follow-up.", "followUp": "6 months", "plainFinding": "Did not resolve without surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37818822/", "sourceText": "Umbilical pilonidal sinus is a rare diagnosis which is characterized by an inflammatory granulomatous reaction to hair shafts penetrating the epidermis. It is most often seen in adolescent male with a hairy abdomen. The patients often present with a history of pain and umbilical discharge. Conservative treatment with hair extraction and personal hygiene is prioritized and surgery is only recommended in recurrent cases. Here one such case is presented, which was resistant to conservative treatment and where surgical excision and primary repair was indicated. No recurrence was observed 6 months postoperatively.", "provenance": [ { "field": "population", "quote": "most often seen in adolescent male with a hairy abdomen" }, { "field": "intervention", "quote": "surgical excision and primary repair was indicated" }, { "field": "comparator", "quote": "Conservative treatment with hair extraction and personal hygiene is prioritized" }, { "field": "primaryOutcome", "quote": "No recurrence was observed 6 months postoperatively" }, { "field": "result", "quote": "No recurrence was observed 6 months postoperatively" }, { "field": "n", "quote": "Here one such case is presented" } ] }, { "id": "pmid:37259676", "pmid": "37259676", "doi": "10.1111/iwj.14242", "nctId": null, "pmcid": "PMC10588333", "title": "Non-operative management of pilonidal sinus disease; classification and outcome", "firstAuthor": "Salih", "multipleAuthors": true, "journal": "Int Wound J", "year": 2023, "design": "prospective-cohort", "n": 3529, "nField": "reported", "population": "patients with sacrococcygeal pilonidal sinus disease, aged 14 to 55", "intervention": "non-surgical treatment using Salih's preparation (an antimicrobial and sclerosing agent)", "comparator": "no comparison group; single-arm study", "primaryOutcome": "recurrence of pilonidal sinus 6 weeks after treatment", "result": "the most significant factor related to recurrence was the presence of an abscess, and patients were divided into three risk classes for recurrence", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "6 weeks", "plainFinding": "Abscess predicts recurrence risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37259676/", "sourceText": "The characteristics of the pilonidal sinus that are associated with recurrence have scarcely been investigated in the literature. This study aims to evaluate the outcomes of patients with sacrococcygeal pilonidal sinus disease who were managed by a non-operative technique using Salih's preparation. This study also tries to classify the patients according to the features that determine the outcome of the intervention. This is a single-group cohort study that enrolled consecutive patients that had pilonidal sinus. All the patients were managed using Salih's preparation. The patients were seen at the clinic 6 weeks after the intervention to record data of recurrence. The Statistical Package for the Social Sciences (SPSS) Version 25 was used for coding and analysing the data. Test of significance and odds ratio were calculated for all of the features. The total number of patients receiving Salih's preparation was 12 123 cases, of which only 3529 patients were included in this study. The mean age of the participants was 26.95 years, ranging from 14 to 55 years. The most significant factor related to the recurrence was the presence of an abscess. After summation of all odd ratios, the percentage of each one from the total was calculated, and accordingly, the patients were divided into three classes. Non-operative methods using a preparation with antimicrobial and sclerosing properties can be an alternative for surgical intervention with a lower risk of recurrence. Classification of patients based on specific criteria can give clinicians and even patients themselves a vision of the chance of recurrence and treatment success.", "provenance": [ { "field": "n", "quote": "of which only 3529 patients were included in this study" }, { "field": "population", "quote": "consecutive patients that had pilonidal sinus" }, { "field": "population", "quote": "The mean age of the participants was 26.95 years, ranging from 14 to 55 years." }, { "field": "intervention", "quote": "All the patients were managed using Salih's preparation." }, { "field": "comparator", "quote": "This is a single-group cohort study that enrolled consecutive patients that had pilonidal sinus." }, { "field": "primaryOutcome", "quote": "The patients were seen at the clinic 6 weeks after the intervention to record data of recurrence." }, { "field": "result", "quote": "The most significant factor related to the recurrence was the presence of an abscess." }, { "field": "result", "quote": "accordingly, the patients were divided into three classes" } ] }, { "id": "pmid:37256592", "pmid": "37256592", "doi": "10.1001/jamasurg.2023.0373", "nctId": null, "pmcid": null, "title": "Management of Pilonidal Disease: A Review", "firstAuthor": "Gil", "multipleAuthors": true, "journal": "JAMA Surg", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal disease", "intervention": "various treatments for pilonidal disease, including conservative care, hair removal, injections, and surgery", "comparator": "different treatment approaches compared with each other (no mention of no treatment or watchful waiting)", "primaryOutcome": "disease recurrence and treatment-related complications", "result": "review found treatment evidence is limited and of poor quality, with no information on whether cysts resolve without treatment", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Reviews treatments, not natural resolution.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37256592/", "sourceText": "IMPORTANCE: The management of pilonidal disease continues to be a challenge due to high rates of recurrence and treatment-associated morbidity. OBSERVATIONS: There is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease and wide practice variation among clinicians. Available treatment options vary considerably in their level of invasiveness, associated morbidity and disability, risks of complications, and effectiveness at preventing disease recurrence. Conservative nonoperative management strategies, including persistent improved hygiene, depilation, and lifestyle modification, focus on disease prevention and minimization of disease activity. Epilation techniques using both laser and intense pulse light therapy are also used as primary and adjunct treatment modalities. Other nonoperative treatment modalities include phenol and fibrin injection to promote closure of pilonidal sinuses. The traditional operative management strategy for pilonidal disease involves excision of affected tissue paired with a variety of closure types including primary midline closure, primary off-midline closure techniques (ie, Karydakis flap, Limberg flap, Bascom cleft lift), and healing by secondary intention. There has been a recent shift toward more minimally invasive operative approaches including sinusectomy (ie, trephination or Gips procedure) and endoscopic approaches. Overall, 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. CONCLUSIONS AND RELEVANCE: Pilonidal disease is associated with significant physical and psychosocial morbidity. Optimal treatments will minimize disease and treatment-associated morbidity. There is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms.", "provenance": [ { "field": "population", "quote": "The management of pilonidal disease continues to be a challenge due to high rates of recurrence and treatment-associated morbidity." }, { "field": "intervention", "quote": "There is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease and wide practice variation among clinicians." }, { "field": "comparator", "quote": "Available treatment options vary considerably in their level of invasiveness, associated morbidity and disability, risks of complications, and effectiveness at preventing disease recurrence." }, { "field": "primaryOutcome", "quote": "effectiveness at preventing disease recurrence" }, { "field": "result", "quote": "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" } ] } ], "faqs": [ { "q": "Do pilonidal cysts go away?", "a": "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." }, { "q": "Can a pilonidal cyst go away on its own?", "a": "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." }, { "q": "Will a pilonidal cyst go away by itself?", "a": "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." }, { "q": "How long does it take for a pilonidal cyst to go away?", "a": "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." }, { "q": "Should I just wait and not treat it?", "a": "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." } ], "searchedAs": [ "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" ], "patientTakeaway": "There's no solid evidence telling you how often a pilonidal cyst clears up on its own or how long that might take — only a single reported case where it happened. If your cyst is mild and symptom-free, regular hair removal around the area has shown similar results to surgery in one study, so that may be a reasonable first step. If you notice growing pain, swelling, or discharge, see a doctor — that points toward an abscess that needs proper care, not more waiting.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"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])" }, "pubmedQueryTranslation": "(\"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])", "searchedOn": "2026-10-13", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Will a Pilonidal Cyst Go Away on Its Own?", "description": "15 studies examined pilonidal cysts and surgery. Evidence that cysts resolve alone is very weak — mostly a single case report, no clear timeline." }, "lastChecked": "2026-10-13", "lastChanged": "2026-10-13", "nextCheckDue": "2026-11-13", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-13" }, "status": "published" }