Treatment of Sebaceous Cysts on the Buttocks
Complete surgical excision is the recommended treatment for non-inflamed sebaceous cysts on the buttocks, while incision and drainage is appropriate for inflamed cysts. 1
Treatment Algorithm Based on Cyst Status
For Non-Inflamed Cysts:
- Standard excision with 4-6 mm margins to mid-subcutaneous adipose tissue is recommended by the American Academy of Dermatology 1
- Complete removal of the entire cyst wall is crucial to prevent recurrence
- Recurrence rates range from 2.2-8.3% when removal is incomplete 1
For Inflamed/Infected Cysts:
- Incision and drainage is the first-line treatment 1
- Options after initial drainage:
- Delayed complete excision after inflammation resolves
- One-stage excision with appropriate antibiotic coverage
Minimally Invasive Techniques
For cosmetically sensitive areas, consider:
- CO2 laser punch-assisted surgery (6% recurrence rate overall, 0% for uninfected cysts) 2
- Two-step laser procedure:
- First, create a small hole with laser to remove cyst contents
- Then remove cyst wall with minimal excision about 1 month later 3
These techniques result in minimal scarring and have high patient satisfaction rates 2.
Antibiotic Considerations
Systemic antibiotics should only be considered in specific situations:
- Temperature >38.5°C
- Heart rate >110 beats/minute
- Erythema extending >5 cm beyond wound margins
- Presence of systemic inflammatory response syndrome 1
First-line oral antibiotic options include dicloxacillin, cephalexin, and clindamycin to target Staphylococcus aureus and streptococci 1.
Post-Operative Care
- Proper wound care with regular dressing changes
- Monitor for signs of infection
- Follow-up within 7-14 days to assess healing and remove sutures 1
Important Considerations
- Histopathological examination is recommended if the cyst has suspicious features:
- Size greater than 1.5 cm
- Rapid growth
- Nodular mass
- Ulceration
- Extensive scarring
- Fixation to surrounding tissues 1
Potential Complications
- Infection
- Rupture leading to inflammation
- Rare malignant transformation to squamous cell carcinoma
- Cosmetic concerns, especially with large or multiple cysts 1
For sebaceous cysts on the buttocks specifically, complete surgical excision with removal of the entire cyst wall remains the gold standard treatment for non-inflamed cysts, while incision and drainage is appropriate for inflamed cysts, with the treatment approach tailored based on whether the cyst is inflamed or non-inflamed.