Should I treat an inflamed sebaceous cyst that is draining?

Management of an Inflamed Draining Sebaceous Cyst

Incision and drainage is the recommended treatment for an inflamed sebaceous cyst that is draining. 1

Primary Treatment Approach

• Incision and drainage (I&D) is the cornerstone of treatment for inflamed sebaceous cysts, particularly when they are draining 1
• Gram stain and culture of pus from inflamed epidermoid cysts (sebaceous cysts) are not recommended as routine practice 1
• After drainage, simply covering the surgical site with a dry dressing is usually the easiest and most effective treatment of the wound 1
• Packing the wound with gauze is not recommended as one small study found it caused more pain and did not improve healing compared to just covering the incision site with sterile gauze 1

Antibiotic Considerations

• Systemic antibiotics are usually unnecessary for inflamed sebaceous cysts unless there are signs of systemic infection 1
• The decision to administer antibiotics should be based on the presence or absence of systemic inflammatory response syndrome (SIRS) such as:
  • Temperature >38°C or <36°C
  • Tachypnea >24 breaths per minute
  • Tachycardia >90 beats per minute
  • White blood cell count >12,000 or <400 cells/µL 1
• If antibiotics are deemed necessary, they should be active against Staphylococcus aureus, which is a common pathogen 1

Special Considerations

• The inflammation in sebaceous cysts typically occurs as a reaction to rupture of the cyst wall and extrusion of its contents into the dermis, rather than as a primary infectious complication 1
• For recurrent sebaceous cysts at the same site, a search for local causes such as foreign material should be conducted 1
• Complete excision of the cyst wall is important to prevent recurrence 2

Alternative Surgical Approaches

• In some cases, the infected tissue can be excised along with a rim of healthy tissue and then closed with sutures in the same sitting 2
• For cysts in cosmetically sensitive areas, alternative approaches may be considered to minimize scarring, though this is less relevant for currently inflamed cysts 3

Follow-up Care

• Monitor for signs of recurrence, which may indicate incomplete removal of the cyst wall 1, 2
• If recurrent infections occur at the same site, consider complete excision of the cyst and its wall once the acute inflammation has resolved 1

Common Pitfalls to Avoid

• Avoid closing the wound without adequate drainage, as this may lead to recurrent infection 1
• Do not routinely prescribe antibiotics unless there are signs of systemic infection or the patient has markedly impaired host defenses 1
• Avoid packing the wound unnecessarily as it may increase pain without improving healing outcomes 1
• Do not confuse sebaceous cysts with other conditions that may require different management approaches 4, 5