The lack of communication with the surface of the skin leads to the formation of a dermal-based epithelial-lined sac filled with keratin. The initial cause of formation of epidermal inclusion cysts is uncertain.
Proposed mechanisms for epidermal inclusion cyst formation include occlusion of pilosebaceous follicles and implantation of epidermal cells into the dermis after penetration injury. The proposed mechanism of implantation of epidermal cells in the dermis after penetration injury is supported by multiple reports of epidermal inclusion cyst formation after surgery or traumatic injury.
The onset of inflammation of the cyst results from rupture to the cyst wall and extrusion of the keratinous contents of the cyst into the dermis. The cause of cyst rupture remains uncertain. Bacterial infection may or may not contribute to cyst rupture.
Some authors argue that bacterial infection does not cause cyst rupture. Others argue that anaerobic bacteria play a role in the inflammatory process.
For patients presenting with multiple epidermal inclusion cysts, one may consider work-up for Gardner syndrome or nevoid basal cell carcinoma syndrome. Nonsurgical treatment options aim to decrease the inflammation and discomfort associated with the keratin granuloma. These methods do not remove the cyst wall, therefore the patient remains at risk for recurrence of inflammation.
Subsequent definitive surgical therapy will be necessary if the patient desires complete removal. Intralesional kenalog can be given, but the concentration should be modified according to the depth, firmness, and age of the scarred cyst. Mature keratin granulomas are typically firmer and thicker and will benefit from injection of a higher concentration e.
Recently developed keratin granulomas frequently have a soft and attenuated cyst wall. Incision and drainage is usually preferred in the acute phase, but injection with a lower concentration of intralesional kenalog e. Bacterial culture and sensitivities can be conducted, followed by the administration of appropriate systemic antibiotics, if an infection is found.
Surgical treatment options aim to relieve pressure by draining cyst contents andprevent recurrence by removing the entire cyst wall and its contents. The timing of the surgery may vary depending on the suspicion of infection and degree of inflammation. Delaying surgery may be prudent if the ruptured cyst is infected. While incision and drainage can relieve pressure and inflammation, it does not remove the cyst wall.
Subsequent excision will be necessary if the patient desires cyst removal. Nevertheless, culture of the cyst contents can detect the presence of bacteria and guide antibiotic choice, if the cyst is infected. Multiple authors have published articles that describe satisfactory outcomes that resulted from extruding the uninflamed cyst and its contents through small incisions.
Minimal excision techniques are frequently not possible for keratin granulomas, however. The ruptured cyst wall lacks integrity and is often dispersed throughout the dermis. Therefore, the surgeon loses his or her ability to visualize the cyst wall. In addition, the inflammation around the ruptured cyst leads to scarring.
The scarred tissue cannot be extracted through a small incision. Wide excision is typically necessary to cure ruptured cysts. Excision during the acute inflammatory phase may lead to increased complications with infection and difficulty suturing, because of the loss of integrity of the dermis immediately around the inflamed cyst.
Incision and drainage during the acute inflammatory phase can relieve pain and inflammation. Antibiotics can be prescribed, pending the results of cultures and sensitivities.
Epidermoid cyst mimicry: report of seven cases and review of the literature. The Journal of Clinical and Aesthetic Dermatology. Weir CB, St. Hilaire NJ. Epidermal inclusion cyst. Updated August 11, Arch Plast Surg. Medline Plus. Epidermoid cyst. Updated Sept 1, Cedars Sinai. Epidermoid cysts of the skin. American Academy of Dermatology. What is a dermatologist?
Overview of Benign Lesions of the Skin. Diagnosing Common Benign Skin Tumors. Am Fam Physician. Your Privacy Rights. To change or withdraw your consent choices for VerywellHealth. At any time, you can update your settings through the "EU Privacy" link at the bottom of any page. These choices will be signaled globally to our partners and will not affect browsing data. We and our partners process data to: Actively scan device characteristics for identification.
I Accept Show Purposes. Table of Contents View All. Table of Contents. See Photo. Signs that may indicate an infection of a sebaceous cyst include: Redness Tenderness Increased temperature of the skin over the cyst it feels warm.
Frequently Asked Questions Will squeezing a sebaceous cyst get rid of it? How can I get rid of a sebaceous cyst on my own? What's inside a sebaceous cyst? What sort of healthcare provider should I go to for a sebaceous cyst? Was this page helpful? Thanks for your feedback!
Sign Up. But if a cyst is bothering you for any reason, see your healthcare provider. A cyst can be injected with steroids. This can reduce inflammation and the cyst may not need to be drained. But infected cysts may need to be cut and drained. To do this, your provider makes a hole in punctures the top and removes the contents. Large cysts can come back after this procedure and may have to be surgically removed excised.
If a cyst becomes swollen, tender, large, or infected, treatment may include antibiotics and then surgery.
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