From the Guidelines
Sebaceous cysts, often actually epidermoid cysts, should be treated with incision and drainage for inflamed cysts, and observation or surgical removal for asymptomatic ones, as the use of systemic antibiotics is rarely necessary 1. When diagnosing a sebaceous cyst, it is essential to differentiate between a true sebaceous cyst and an epidermoid cyst, as the treatment approach may vary.
- Key characteristics of sebaceous cysts include a closed sac filled with keratin and sebum under the skin, often appearing as a painful, tender, and fluctuant red nodule.
- Epidermoid cysts, on the other hand, contain skin flora in the cheesy keratinous material and are usually polymicrobial, containing bacteria that constitute the normal regional skin flora. Treatment options for sebaceous cysts depend on the size, symptoms, and whether the cyst is infected.
- For small, asymptomatic cysts, observation is often the recommended course of action, as many sebaceous cysts are harmless and may resolve on their own.
- For larger, painful, or infected cysts, incision and drainage is the preferred treatment, as it allows for the evacuation of pus and the probing of the cavity to break up loculations 1.
- Systemic antibiotics, such as cephalexin, are rarely necessary, 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. It is crucial to avoid squeezing or attempting to drain sebaceous cysts at home, as this can lead to infection and scarring.
- Instead, warm compresses can be applied to the area to reduce inflammation and discomfort.
- Surgical removal, either complete excision of the cyst with its wall or incision and drainage, is often the definitive treatment for larger, painful, or infected cysts, and can help prevent recurrence.
From the Research
Diagnosis of Sebaceous Cyst
- The diagnosis of a sebaceous cyst is typically based on clinical examination, with the presence of a palpable, usually painless, lump or nodule under the skin 2, 3, 4, 5, 6.
Treatment Options for Sebaceous Cyst
- Incision and drainage is a common management plan for infected sebaceous cysts, but alternative methods such as suture closure, intraoral approach, CO2 laser punch-assisted minimally invasive surgery, and minimal postponed excision have been proposed as effective treatments 2, 3, 4, 5.
- Surgical removal of the cyst can be accomplished through an external incision, but this may result in a scar; alternative approaches such as intraoral incision or CO2 laser punch can help avoid visible scarring 3, 4.
- Minimally invasive techniques, such as laser punch-assisted surgery or minimal excision, have been shown to be effective in removing the cyst with minimal scarring and high patient satisfaction 4, 5, 6.
- The choice of treatment may depend on the location, size, and infection status of the cyst, as well as patient preferences and cosmetic concerns 2, 3, 4, 5, 6.
Surgical Techniques for Sebaceous Cyst Removal
- Traditional surgical excision involves removing the cyst through an external incision, but this may be complicated and result in obvious scarring 4.
- CO2 laser punch-assisted minimally invasive surgery involves creating a small hole in the skin to remove the cyst contents, followed by removal of the cyst wall using a hemostat 4.
- Minimal postponed excision involves removing the cyst content with a laser punch, followed by removal of the cyst wall with a minimal excision about 1 month later 5.
- Intraoral approach involves making an incision inside the mouth to remove the cyst, which can help avoid visible scarring on the face 3.