From the Guidelines
The recommended treatment for epidermal cysts is incision and drainage for inflamed cysts, as stated by the Infectious Diseases Society of America guidelines 1. For asymptomatic epidermal cysts, observation is typically the recommended approach, as these benign growths often require no intervention. However, for symptomatic or cosmetically bothersome cysts, complete surgical excision is the definitive treatment, which involves removing the entire cyst wall and contents to prevent recurrence. This minor procedure is usually performed under local anesthesia in an outpatient setting. Some key points to consider in the treatment of epidermal cysts include:
- Avoiding gram stain and culture of pus from inflamed epidermoid cysts, as it is not recommended 1
- Considering the use of oral antibiotics, such as cephalexin or clindamycin, for patients with systemic inflammatory response syndrome (SIRS) or markedly impaired host defenses 1
- Using warm compresses to provide symptomatic relief for inflamed cysts while waiting for medical treatment
- Advising patients to avoid squeezing or attempting to drain cysts at home, as this can lead to infection, scarring, and doesn't address the underlying cyst wall. In terms of specific antibiotic regimens, the choice of antibiotic should be guided by the presence or absence of SIRS, as well as the patient's underlying health status and potential allergies 1. It's also important to note that intralesional corticosteroid injections may help reduce inflammation in some cases, but this should be considered on a case-by-case basis. Overall, the goal of treatment for epidermal cysts is to relieve symptoms, prevent recurrence, and minimize the risk of complications, while also considering the patient's quality of life and potential morbidity and mortality associated with the treatment approach.
From the Research
Treatment Options for Epidermal Cysts
- The treatment of choice for epidermal cysts is surgical excision 2.
- A minimal excision technique can be used for epidermoid cyst removal, which is less invasive than complete surgical excision and does not require suture closure 3.
- For inflamed cysts, it is often preferable to postpone excision until inflammation has subsided 3.
- Incision and drainage with oral antibiotic therapy or intralesional steroid injection may be required if the cyst becomes ruptured 2.
Management of Epidermal Cysts Arising from Scar Tissues
- The standard course of treatment for epidermal cysts arising from scar tissues has not been established, but total scar revisions with complete EC excisions, partial scar tissue excisions with complete EC excisions, or laser therapy for the scar and EC can be effective 4.
- Surgeons and patients should decide whether the ECs and scar tissue should be completely removed, and consideration should be given to the options chosen for the management of ECs 4.
Use of Antibiotics for Inflamed Epidermal Cysts
- The majority of physicians use antibiotics for the treatment of inflamed EICs, despite the differences between general practitioners and dermatologists in diagnosis 5.
- The use of antibiotics for inflamed epidermal cysts is of concern due to cost and bacterial resistance 5.