From the Guidelines
For a subdermal cyst, incision and drainage is the recommended treatment if it becomes inflamed, as this approach is strongly supported by high-quality evidence. This method is effective in treating inflamed epidermoid cysts, which are a type of subdermal cyst, as stated in the 2014 update by the Infectious Diseases Society of America 1. According to this guideline, incision and drainage is the recommended treatment for inflamed epidermoid cysts.
When considering the management of subdermal cysts, it's essential to differentiate between inflamed and uninflamed cysts. For uninflamed cysts, treatment may not be necessary unless they become symptomatic or cosmetically bothersome. However, if a cyst becomes infected, as indicated by signs of inflammation, redness, or drainage, medical attention is required. In such cases, antibiotics may be prescribed, but the decision to administer them should be based on the presence of systemic inflammatory response syndrome (SIRS), as recommended by the guidelines 1.
Key points to consider in the management of subdermal cysts include:
- Avoiding self-drainage or squeezing the cyst to prevent infection or scarring
- Applying warm compresses to reduce inflammation if the cyst becomes tender
- Seeking medical attention if the cyst becomes red, painful, or starts draining, as these signs may indicate infection
- Considering surgical excision for symptomatic cysts to prevent recurrence
It's also important to note that subdermal cysts, including epidermoid cysts, typically contain skin flora, and their inflammation is often a reaction to the rupture of the cyst wall rather than an infectious complication, as discussed in the 2005 practice guidelines for the diagnosis and management of skin and soft-tissue infections 1. However, the most recent and highest quality evidence from 2014 should guide clinical decision-making 1.
From the Research
Subdermal Cyst Treatment Options
- Percutaneous sclerotherapy is a treatment option for cystic lesions, including subdermal cysts, as described in 2.
- Aspiration and sclerotherapy can be effective in managing symptomatic cysts, but may not provide long-term control in all cases, as seen in 3.
Sclerotherapy Agents and Techniques
- A 95% alcohol solution can be used as a sclerosing agent for hepatic cysts, as described in 4.
- Tetracycline solution can be used for renal cysts, providing both sclerosing action and antibiotic prophylaxis, as described in 5.
Efficacy and Safety of Aspiration-Sclerotherapy
- Aspiration-sclerotherapy can be an effective first-line therapy for symptomatic simple renal cysts, with a high treatment success rate and low complication rate, as reported in 6.
- The use of a sclerosing agent is integral to treatment success, but the optimum agent, volume, injection frequency, and dwelling time are yet to be defined, as noted in 6.