Management of Draining Sebaceous Cysts
Incision and drainage with thorough evacuation of the cyst contents, followed by application of triple antibiotic ointment and a dressing, is the appropriate treatment for a draining sebaceous cyst. 1
Initial Management
The approach taken for this 67-year-old male patient with a draining sebaceous cyst was appropriate and aligns with current guidelines:
- Disinfection of the area
- Application of pressure to evacuate drainage
- Continued pressure until clean blood was observed
- Cleaning the area
- Application of triple antibiotic ointment
- Covering with a band-aid
- Scheduling follow-up for wound check
This approach follows the Infectious Diseases Society of America (IDSA) guidelines, which recommend incision and drainage as the cornerstone of treatment for inflamed epidermoid cysts 2, 1.
Evidence-Based Management Principles
Drainage Technique
- The most important therapy for an infected sebaceous cyst is to open the incision, evacuate the infected material, and continue dressing changes until the wound heals by secondary intention 2
- Thorough evacuation of the cyst contents is essential to prevent recurrence
- Probing the cavity to break up loculations may be necessary in larger cysts
Antibiotic Use
- For small cysts (<5 cm of erythema/induration) with minimal systemic signs of infection (temperature <38.5°C, WBC <12,000 cells/μL, pulse <100 beats/minute), antibiotics are unnecessary 2
- Studies of subcutaneous abscesses found little or no benefit for antibiotics when combined with drainage 2
- Topical antibiotics (as used in this case) may help prevent secondary infection of the wound
Post-Procedure Care
- Keep the wound clean and dry
- Monitor for signs of infection
- Schedule follow-up to assess wound healing (as was done in this case)
- Dressing changes should continue until the wound heals by secondary intention 1
When to Consider Systemic Antibiotics
Systemic antibiotics should be considered only in specific situations:
- Temperature >38.5°C or heart rate >110 beats/minute
- Erythema extending beyond wound margins for >5 cm
- Presence of systemic inflammatory response syndrome (SIRS)
- Markedly impaired host defenses
- Extensive surrounding cellulitis
- Failed initial treatment 2, 1
Follow-Up Care
The plan for follow-up the next day is appropriate. During follow-up, clinicians should:
- Assess for proper wound healing
- Check for signs of infection (increasing erythema, purulence, fever)
- Consider additional drainage if necessary
- Continue wound care with dressing changes until healed
Prevention of Recurrence
To prevent recurrence of sebaceous cysts:
- Complete surgical excision with removal of the entire cyst wall is recommended for non-inflamed cysts 1
- For currently inflamed/infected cysts, complete excision should be delayed until the acute infection resolves
- Consider definitive surgical excision after the current infection has completely resolved 1
Potential Complications to Monitor
- Recurrence (rates range from 2.2-8.3% depending on technique) 1
- Secondary infection
- Scarring
- Rarely, malignant transformation (though extremely uncommon) 3, 4
The management approach used for this patient follows evidence-based guidelines and should lead to resolution of the current infection. Once healed completely, the patient may benefit from complete surgical excision to prevent recurrence.