Go back

INDEX

    Sebaceous Cyst – Treatment

    Dermatology

    Last Updated May 03, 2021
    Read Disclaimer
    By Julian Marsden, Melissa Lee

    Context

    • Sebaceous (or epidermoid) cyst is a common benign lesion presenting as a solid, raised subepidermal nodule filled with a mixture of lipids called sebum.
      • Classically present as skin-coloured dermal nodules, often with a clinically visible central punctum (Figure 1 and 2).
        • Cosmetic concern; infected and occasionally painful.
      • Lesions can present anywhere but primarily present on the scalp, face, neck upper back and upper chest.
      • Size ranges from a few millimeters to several centimeters in diameter.
    • Pathophysiology
      • Plugging of the follicular orifice of the sebaceous gland (oil producing gland).
      • Common in those with acne vulgaris.
    • Due to the inflammatory reaction from the release of lipid contents, practitioners will mistake sebaceous for an abscess and prescribe antibiotics.

    Evaluation

    • Clinical diagnosis based on clinical appearance of a discrete cyst or nodule, often with a central punctum, that is freely movable on palpation.
    • Diagnosis is confirmed by histologic examination but is rarely needed.

    Figure 1. Epidermoid (sebaceous) cyst presenting as a skin-colored subcutaneous nodule.

    Figure 2. A central punctum corresponding to the follicular opening is often visible on the epidermoid cyst.

    Recommended Treatment

    • Inflamed, uninfected sebaceous cysts may resolve spontaneously without therapy. Treatment is not necessary unless desired by the patient.
    • Excision should be delayed if an active infection is present. In this case, an initial incision and drainage may be indicated with potential for recurrence in the future.
    • If the cyst has ruptured and the cyst wall lining is destroyed, the cyst often will not reoccur.

    Injection

    • For inflamed, non-fluctuant lesions and complications of cyst rupture such as erythema, swelling and pain.
    • Injection of intralesional triamicinolone acetonide (3 mg/mL for the face and 10 mg/mL for the trunk) into the inflamed lesion improves resolution of inflammation and may prevent infection and the need for incision and drainage.
    • For fluctuant lesions, excision or incision techniques may be used as described below.

    Excision

    • Excision is best accomplished when the lesion is not inflamed as inflammation increases recurrence as tissue planes less distinct.
    • Minimal excision technique is used to rupture the cyst and drain its contents. The cyst wall is removed through the incision.

    Incision and Drainage

    • For noninflamed, non-ruptured and noninfected cysts.
    • Punch incision technique (4 mm punch) or minimal incision technique (no. 11 blade) can be used to remove uncomplicated cysts. The cyst content is then drained by exerting a vigorous lateral pressure on the cyst.
    • Anesthesia with 1% lidocaine should be injected around the lesion to avoid rupturing the cyst wall with the pressure of the anesthetic agent.
    • The minimal incision technique provides better cosmetic results than the standard excision and is useful for cysts in cosmetically sensitive areas.

    Criteria For Hospital Admission

    • Most sebaceous cysts can be managed as an outpatient.

    Criteria For Transfer To Another Facility

    • Most sebaceous cysts do not require transfer to another facility.

    Criteria For Close Observation And/or Consult

    • Consultations are not necessary unless the cyst is large and in a cosmetically important location such as the mouth or face. In this case, refer to a dermatologist/plastic surgeon.
    • Adults with epidermoid cysts in rare locations such as the fingers and toes, history of multiple lipomas, and a family history of colon cancer should raise the suspicion of Gardner syndrome with an appropriate specialist referral.
    • Rare malignancy can arise. Squamous cell carcinoma is the most common malignancy followed by basal cell carcinoma. A consultation may be warranted.

    Criteria For Safe Discharge Home

    • Following surgical excision, contact sports and strenuous activity should be avoided.
    • Sutures may be removed within 7-10 days.
    • Patients should be instructed that the surgical scar will generally take 8 weeks to reach a maximum of 80% tensile strength of the original skin strength.
    • Scar revision, if necessary, should take place between 6 months to 1 year following excision as the remodeling phase of wound healing occurs between 3 weeks to 1 year.

    Related Information

    Reference List

    RESOURCE AUTHOR(S)

    COMMENTS (0)

    Add public comment…