From the Guidelines
The primary treatment for an infected epidermoid cyst is incision and drainage, with antibiotics directed against S. aureus considered as an adjunct based on the presence or absence of systemic inflammatory response syndrome (SIRS) 1.
Treatment Overview
The treatment approach for an infected epidermoid cyst focuses on addressing the infection and preventing further complications. Key considerations include:
- Incision and drainage: This is the recommended initial treatment for inflamed epidermoid cysts, as it allows for the removal of infected material and helps to reduce the risk of further infection or abscess formation 1.
- Antibiotic use: The decision to use antibiotics should be based on the presence of SIRS, such as fever, tachypnea, tachycardia, or abnormal white blood cell count 1. Antibiotics directed against S. aureus, such as cephalexin, dicloxacillin, or clindamycin, may be considered in these cases.
- Pain management: Over-the-counter pain medications like acetaminophen or ibuprofen can help manage pain and discomfort associated with the infection.
- Wound care: After incision and drainage, the wound should be kept clean and dry to promote healing. Warm compresses can help reduce pain and promote drainage.
Specific Treatment Recommendations
- For mild infections, incision and drainage may be sufficient, with antibiotics considered if SIRS is present 1.
- For more severe infections or those with significant SIRS, antibiotics should be used in conjunction with incision and drainage 1.
- In cases where the cyst is recurrent or particularly problematic, complete surgical excision may be necessary once the acute infection has resolved 1.
Evidence-Based Practice
The treatment guidelines for infected epidermoid cysts are based on evidence from studies published in reputable medical journals, such as the Clinical Infectious Diseases journal 1. These guidelines emphasize the importance of incision and drainage as the primary treatment, with antibiotics used judiciously based on the presence of SIRS. By following these evidence-based guidelines, healthcare providers can provide effective treatment for infected epidermoid cysts and improve patient outcomes.
From the Research
Treatment Guidelines for Epidermoid Cyst Infection
- The treatment of choice for epidermoid cysts is surgery, as it allows for the complete removal of the cyst wall, reducing the risk of relapse 2.
- In cases of infection, antibiotics may be prescribed to manage the infection before or after surgery.
- A study on community-acquired methicillin-resistant Staphylococcus aureus (MRSA) skin infections found that empiric treatment with cephalexin, followed by double-strength trimethoprim/sulfamethoxazole, was effective in resolving the infection 3.
- Another study compared the use of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for the treatment of uncomplicated cellulitis and found no significant difference in clinical cure rates between the two groups 4.
- For smaller skin abscesses, a placebo-controlled trial found that clindamycin or trimethoprim-sulfamethoxazole, in conjunction with incision and drainage, improved short-term outcomes compared to incision and drainage alone 5.
- A survey of antibiotic prescription use for inflamed epidermal inclusion cysts found that the majority of physicians, including primary care physicians and dermatologists, prescribe antibiotics for the treatment of inflamed EICs, despite the controversy surrounding the mechanism of inflammation or suppuration 6.
Antibiotic Treatment
- Cephalexin, trimethoprim-sulfamethoxazole, and clindamycin are commonly used antibiotics for the treatment of epidermoid cyst infections 3, 4, 5.
- The choice of antibiotic should be based on the severity of the infection, the presence of MRSA, and the patient's medical history and allergies.
- It is essential to note that antibiotic treatment should be used judiciously to minimize the risk of bacterial resistance and side effects.