Is packing ribbon recommended for wound care in an infected epidermoid cyst?

From the Guidelines

Packing ribbon is not recommended for wound care in an infected epidermoid cyst. The preferred treatment approach for an infected epidermoid cyst involves incision and drainage (I&D) of the cyst, followed by complete removal of the cyst wall when the infection has resolved 1. After drainage, the wound should be left open to heal by secondary intention rather than packed with ribbon. This approach is supported by the 2014 update by the Infectious Diseases Society of America, which recommends incision and drainage as the treatment for inflamed epidermoid cysts, carbuncles, abscesses, and large furuncles 1.

The cavity should be gently cleaned with normal saline or antiseptic solution during dressing changes. Patients should be prescribed appropriate antibiotics such as cephalexin 500mg four times daily for 7-10 days or clindamycin 300mg four times daily for patients with penicillin allergy. Packing is generally avoided because it can potentially introduce additional bacteria, cause unnecessary pain, delay healing, and may not effectively remove the cyst contents 1.

Some key points to consider in the treatment of infected epidermoid cysts include:

• Incision and drainage is the recommended treatment 1
• Gram stain and culture of pus from inflamed epidermoid cysts are not recommended 1
• The decision to administer antibiotics should be made based on the presence or absence of systemic inflammatory response syndrome (SIRS) 1
• Complete excision of the cyst wall during a separate procedure after the infection resolves is crucial to prevent recurrence 1.

Overall, the goal of treatment is to effectively manage the infection, promote healing, and prevent recurrence, while minimizing the risk of complications and improving the patient's quality of life.

From the Research

Wound Care for Infected Epidermoid Cysts

• The use of packing ribbon in wound care for infected epidermoid cysts is not explicitly mentioned in the provided studies 2, 3, 4, 5, 6.
• However, the treatment of infected epidermoid cysts often involves incision and drainage, followed by removal of the cyst wall and delayed primary closure 5.
• The study by 5 describes a surgical approach for treating infected epidermoid cysts using delayed primary closure, but does not mention the use of packing ribbon.
• Another study 3 discusses the minimal excision technique for epidermoid cyst removal, which involves expressing the cyst contents and extracting the cyst wall, but also does not mention packing ribbon.
• The provided studies focus on the treatment and management of epidermoid cysts, including surgical excision and antibiotic prescription use 2, 3, 4, 6, but do not provide information on the use of packing ribbon in wound care.

Treatment of Infected Epidermoid Cysts

• Infected epidermoid cysts are typically treated with incision and drainage, followed by removal of the cyst wall and delayed primary closure 5.
• Antibiotics may be prescribed for the treatment of inflamed or infected epidermoid cysts, with 84% of general practitioners and 94% of dermatologists choosing antibiotics for treatment 6.
• The treatment of choice for epidermoid cysts is surgery, with most cases being performed under local anesthesia 2.
• Complete excision of the cyst wall is necessary to avoid relapses 2.