From the Guidelines
The treatment approach for both sebaceous cysts and epidermoid cysts involves incision, thorough evacuation of the contents, and probing the cavity to break up loculations, with systemic antibiotics rarely necessary unless there are signs of infection or severe systemic manifestations 1. When it comes to treating these cysts, the key is to differentiate between asymptomatic and infected cysts. For asymptomatic cysts, observation or complete surgical excision can be considered, as these are benign lesions.
- Complete surgical excision is the definitive treatment for both types of cysts, involving making a small incision over the cyst, carefully dissecting and removing the entire cyst wall (sac) along with its contents to prevent recurrence.
- For infected cysts, incision and drainage is performed first to relieve pain and inflammation, often without the need for systemic antibiotics, unless there are unusual exceptions such as multiple lesions, cutaneous gangrene, severely impaired host defenses, extensive surrounding cellulitis, or severe systemic manifestations of infection 1. Some important considerations in the treatment approach include:
- The location of the cyst, with facial cysts requiring more careful technique to minimize scarring, while cysts in hair-bearing areas need complete removal to prevent recurrence.
- The use of alternative treatments like intralesional corticosteroid injections, which may temporarily reduce inflammation but don't eliminate the cyst.
- The fact that epidermoid cysts, often erroneously labeled “sebaceous cysts,” ordinarily contain skin flora in the cheesy keratinous material, even when uninflamed, and cultures of inflamed cysts also yield the same organisms, suggesting that the inflammation and purulence occur as a reaction to rupture of the cyst wall and extrusion of its contents into the dermis, rather than as an infectious complication 1.
From the Research
Treatment Approaches
The treatment approaches for sebaceous cysts and epidermoid cysts share some similarities, but also have distinct differences.
- For sebaceous cysts, a study published in 2017 2 suggests that incision and drainage, followed by excision of the infected tissue and closure with sutures, can be an effective treatment approach.
- In contrast, epidermoid cysts are typically treated with surgical excision, with the goal of removing the entire cyst wall to prevent recurrence 3.
- A minimal excision technique can also be used for epidermoid cysts, which involves making a small incision and extracting the cyst contents and wall through the incision 4.
Key Considerations
- For both types of cysts, it is essential to consider the potential for malignant transformation, although this is rare 5.
- In cases where there is a high suspicion of malignancy, surgical excision and histopathological evaluation are crucial for diagnosis and treatment 5.
- Inflamed cysts can be challenging to excise, and it may be necessary to postpone treatment until the inflammation has subsided 4.
Surgical Excision
- Surgical excision is a common treatment approach for both sebaceous and epidermoid cysts.
- The goal of surgical excision is to remove the entire cyst, including the cyst wall, to prevent recurrence 3.
- In some cases, surgical excision may need to be performed under general anesthesia, while in other cases, local anesthesia may be sufficient 2, 3.