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Natural Image Orange County Cosmetic Dermatology and Cosmetic Surgery

Sebaceous Cysts

"It feels like a little marble". The culprit is probably a sebaceous cyst, which is non-cancerous, usually moveable and liable to pop up almost anywhere that hair grows. Cysts are extremely common, forming when dead skin plus the oily secretions of the dead skin cells, which usually shed monthly, get trapped under a clogged pore.

DermAtlas: EAR - cyst, epidermal inclusion
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Dermatlas

They're annoying and they don't often go away on their own. You can't prevent cyst formation, but do avoid comedogenic skin care preparations (look for oil-free and non-comedogenic creams).

Symptoms

If you have any of these symptoms do not assume it is due to a cyst. These symptoms may be caused by other conditions as well.

  • Small, dome-shaped lump beneath the skin
  • Foul-smelling, cheesy-like material draining from the cyst
  • Redness or tenderness on or around the cyst if it becomes inflamed

Causes

Blocked sebaceous glands, swollen hair follicles, and excessive testosterone production will cause such cysts.

Common Locations for Sebaceous Cysts

The scalp, ears, back, face, and upper arm, are common sites for sebaceous cysts, though they may occur anywhere on the body. In males a common place for them to develop is the scrotum and chest. They are more common in hairier areas, where in cases of long duration they could result in hair loss on the skin surface immediately above the cyst. They are smooth to the touch, vary in size, and are generally round in shape.

They are generally mobile masses that can consist of:

  • fibrous tissues and fluids
  • a fatty, (keratinous), substance that resembles cottage cheese, in which case the cyst may be called "keratin cyst"
  • a somewhat viscous, serosanguineous fluid (containing purulent and bloody material)

The nature of the contents of a sebaceous cyst, and of its surrounding capsule, will be determined by whether the cyst has ever been infected.

Treatment

Treatment options include the following:

  • Surgical excision - Removal of the entire cyst, including its contents and cyst wall.
  • Surgical drainage - Cutting open the cyst, draining the contents, and removing the cyst wall. The cyst might come back, though.
  • Steroid injection - Injecting steroids into the cyst to reduce inflammation. The cyst is not removed, though.
  • Antibiotics - These may be prescribed to reduce the risk of an infection after surgery or drainage.

Surgical Removal of Sebaceous Cysts

With surgery, a cyst can usually be excised in its entirety. Poor surgical technique or previous infection leading to scarring and tethering of the cyst to the surrounding tissue may lead to rupture during excision and removal. A completely removed cyst will not recur, though if the patient has a predisposition to cyst formation, further cysts may develop in the same general area.

Surgical excision of a sebaceous cyst is a simple procedure to completely remove the sac and its contents. The excision is done in the office and typically will take about 30 minutes.

Does it hurt to remove a cyst?

No. The area is first numbed so all you’ll feel is some pressure and prodding. The typical outpatient surgical procedure for cyst removal is to numb the area around the cyst with a local anesthetic, then to use a scalpel to open the lesion with either a single cut down the center of the swelling, or an oval cut on both sides of the center point.

If the cyst is small, it may be lanced instead. The first step involves squeezing out the keratin (the semi-solid material consisting principally of sebum and dead skin cells) surrounding the cyst, then using blunt-headed scissors or another instrument to hold the incision wide open while using fingers or forceps to try to remove the cyst intact.

If the cyst can be removed in one piece, the "cure rate" is 100%. If, however, it is fragmented and cannot be entirely recovered, Dr. Sikorski may use curettage (scraping) to remove the remaining exposed fragments, then burn them with an electro-cauterization tool, in an effort to destroy them in place. In such cases the cyst may or may not recur.

In either case, the incision is then disinfected and, if necessary, the skin is stitched back together over it. A scar will most likely result. In some cases where "cure rate" is not 100% the resulting hole is filled with an antiseptic ribbon after washing it with an iodine based solution. This is then covered with a field dressing. The ribbon and the dressing are to be changed once or twice daily for 7-10 days after which the incision is sewed up.

An infected cyst may require oral antibiotics or other treatment before and/or after excision.

Other naming for sebaceous cyst include epidermoid cyst, keratin cyst, epidermal cyst.

Starting Point To Learn What's Right For You

Not sure where to start? Give us a call and chat with our patient coordinator Michelle. Call the office at (949) 448-0487 or Request a callback through this online form.

Natural Image Orange County MedCenter Cosmetic Dermatology, Medical Dermatology, and Cosmetic Surgery

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