From the Guidelines
The most effective intervention for a sebaceous (epidermoid) cyst is incision, thorough evacuation of the contents, and probing the cavity to break up loculations, as this approach addresses the root cause of the cyst and prevents recurrence. This method is supported by the practice guidelines for the diagnosis and management of skin and soft-tissue infections, which suggest that effective treatment of inflamed epidermoid cysts entails incision and evacuation of the cyst contents 1.
When considering treatment options, it's essential to note that:
- Epidermoid cysts, often mislabeled as sebaceous cysts, contain skin flora in the cheesy keratinous material, even when uninflamed 1.
- Inflamed cysts yield the same organisms, suggesting that inflammation occurs as a reaction to rupture of the cyst wall and extrusion of its contents into the dermis, rather than as an infectious complication 1.
- Gram stain, culture, and systemic antibiotics 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.
In terms of specific treatment approaches:
- Simply covering the surgical site with a dry dressing is usually the easiest and most effective treatment of the wound 1.
- Some clinicians may pack the wound with gauze or suture it closed, but this is not always necessary 1.
- Over-the-counter pain relievers like acetaminophen or ibuprofen can manage associated pain, but complete removal of the cyst is the definitive treatment 1.
It's crucial to prioritize evidence-based treatments that address the underlying cause of the cyst, rather than just managing symptoms or attempting to drain the cyst at home, which can lead to infection and recurrence.
From the Research
Treatment Options for Sebaceous Cysts
- Various studies have investigated different treatment options for sebaceous cysts, including CO2 laser punch-assisted minimally invasive surgery 2, minimal surgical excision 3, intraoral approach 4, laser punch and minimal postponed excision 5, and suture closure 6.
Minimally Invasive Surgery
- CO2 laser punch-assisted minimally invasive surgery has been shown to be a convenient, effective, and minimally-invasive treatment option for sebaceous cysts, with minimal scarring and high patient satisfaction 2.
- This method involves pre-separating the cyst wall from surrounding tissues, removing the cyst contents through a small hole created by a CO2 laser, and then removing the cyst wall using a hemostat.
Alternative Methods
- Minimal surgical excision has been reported to have a low recurrence rate of 0.66% in a series of 302 patients 3.
- Intraoral approach has been used to excise sebaceous cysts located in the lip or cheek near lip commissure, avoiding a visible scar on the skin 4.
- Laser punch and minimal postponed excision has been proposed as a new method for treating sebaceous cysts, involving removal of the cyst content with a laser punch and the cyst wall with a minimal postponed excision 5.
Management of Infected Sebaceous Cysts
- A new approach for managing infected sebaceous cysts involves excising the infected tissue along with a rim of healthy tissue and then closing the wound by suture, resulting in quick recovery and no need for frequent dressing 6.