From the Guidelines
To treat an inflamed epidermal cyst, incision and drainage is the recommended treatment, as it is the most effective way to relieve pressure and remove the contents of the cyst. This approach is supported by the Infectious Diseases Society of America's 2014 update on practice guidelines for the diagnosis and management of skin and soft tissue infections 1. The guidelines state that incision and drainage is the recommended treatment for inflamed epidermoid cysts, carbuncles, abscesses, and large furuncles, with a strong, high level of evidence.
When considering treatment options, it is essential to prioritize morbidity, mortality, and quality of life as the primary outcomes. In the case of inflamed epidermal cysts, incision and drainage has been shown to be the most effective treatment in reducing symptoms and preventing complications. The decision to administer antibiotics should be based on the presence or absence of systemic inflammatory response syndrome (SIRS), as outlined in the guidelines 1.
Some key points to consider when treating an inflamed epidermal cyst include:
- Avoiding squeezing or attempting to drain the cyst yourself, as this can worsen infection and cause scarring
- Using warm compresses to reduce inflammation and promote drainage
- Managing pain and reducing inflammation with over-the-counter pain relievers such as ibuprofen or acetaminophen
- Considering complete surgical excision once inflammation subsides to prevent recurrence, as this involves removing the entire cyst wall.
It is also important to note that gram stain and culture of pus from inflamed epidermoid cysts are not recommended, as stated in the guidelines 1, and that the use of antibiotics should be reserved for cases with systemic inflammatory response syndrome (SIRS) or other severe complications. Overall, incision and drainage remains the most effective treatment for inflamed epidermal cysts, and should be prioritized in clinical practice.
From the Research
Treatment Options for Inflamed Epidermal Cysts
- Incision and drainage with culture and appropriate therapy is a viable therapeutic option in uncomplicated inflamed EIC lesions, as almost half of cases of mild inflamed EIC (lacking systemic symptoms) cultured will not grow pathogenic bacteria 2
- Surgery is the treatment of choice for epidermoid cysts, with most cases able to be performed under local anesthesia and a low complication rate of 2.2% 3
- To avoid relapses, the cyst wall has to be removed completely 3
Use of Antibiotics
- Prior studies have demonstrated that at least 20% of lesions are culture negative, suggesting that empiric antibiotics may not always be warranted 2
- A survey of physicians found that 84% of general practitioners and 94% of dermatologists chose antibiotics for treatment of inflamed EICs, despite the potential for over-prescription 4
- The use of antibiotics for inflamed EICs is a concern due to cost and bacterial resistance, and alternative treatment options such as incision and drainage should be considered 2, 4