Management of Multiple Infected Sebaceous Cysts on the Face
Surgical excision and histopathological examination of multiple infected sebaceous cysts can be safely performed in an outpatient clinic setting without requiring hospital admission.
Assessment of Infected Sebaceous Cysts
- Sebaceous cysts (more accurately termed epidermoid cysts) are benign encapsulated, subepidermal nodules filled with keratin material 1.
- Infected cysts present with pain, tenderness, and progressive increase in size, often affecting daily activities 2.
- Ultrasound confirmation helps differentiate these cysts from other skin lesions 3.
Outpatient Management Approach
Indications for Outpatient Procedure
- Uncomplicated skin and soft tissue infections (SSTIs) including infected sebaceous cysts can be managed in outpatient settings 4.
- According to IDSA guidelines, most patients with uncomplicated SSTIs can be treated with either empiric antibiotic therapy or simple surgical drainage in an outpatient setting 4.
- Infected sebaceous cysts on the face are classified as non-necrotizing infections that don't require hospitalization unless there are specific complicating factors 4.
Surgical Technique for Outpatient Excision
- The standard practice for management involves complete excision under local anesthesia with a narrow rim (2 mm) of normal skin 4.
- The incision should be elliptical with the long axis parallel to the skin lines to allow for optimal cosmetic results 4.
- For infected cysts, the infected tissue should be excised along with a rim of healthy tissue 2.
- Tissue should be removed using a scalpel rather than laser or electrocautery to preserve histological features 4.
Post-Procedure Care
- Simply covering the surgical site with a dry dressing is usually sufficient for wound management 4.
- Some clinicians may pack the wound with gauze or suture it closed depending on the specific case 4.
- Sutures are typically removed after 14 days for facial lesions 2.
Indications for Hospital Admission
Hospital admission should be considered only if the patient presents with:
- Signs of systemic toxicity (fever, tachycardia, tachypnea, and/or hypotension) 4.
- Extensive surrounding cellulitis that may indicate spreading infection 4.
- Severely impaired host defenses that may complicate healing 4.
- Multiple lesions with severe systemic manifestations of infection 4.
- Suspected necrotizing infection requiring aggressive surgical debridement 4.
Histopathological Examination
- All excised tissue must be sent for histopathological examination 4.
- While malignant transformation is rare (0.3% incidence), histopathological confirmation is important, particularly when there are suspicious clinical features 3.
- The histopathological report should confirm the benign nature of the cyst and rule out any malignant changes 3.
Benefits of Outpatient Management
- Outpatient management provides quick recovery and reduces the risk of hospital-acquired infections 2.
- It is cost-effective and time-saving compared to inpatient management 2.
- For facial lesions, proper surgical technique can minimize scarring and optimize cosmetic outcomes 5.
Special Considerations for Facial Cysts
- For cysts located on the face, particularly near the lip commissure, specialized approaches (such as intraoral) may be considered to avoid visible scarring 5.
- Facial location requires meticulous technique to prevent complications and optimize cosmetic results 5.