What is the treatment for an epidermoid cyst on the finger?

Treatment of Epidermoid Cyst on the Finger

The primary treatment for an epidermoid cyst on the finger is incision and drainage, followed by complete excision of the cyst wall once inflammation has resolved to prevent recurrence. 1

Initial Management of Inflamed Epidermoid Cyst

• For an inflamed or draining epidermoid cyst, incision and drainage is the cornerstone of treatment 1
• Make a small 2-3 mm incision, express the cyst contents through compression, and extract the cyst wall through the incision 2
• Simply cover the surgical site with a dry dressing after drainage rather than packing the wound with gauze, as packing may increase pain without improving healing outcomes 1
• Protect yourself from spraying of cyst contents during the procedure by using gauze or a splatter shield 2
• Gram stain and culture of the cyst contents are not routinely recommended 1

Definitive Treatment

• Complete excision of the cyst and its wall is the definitive treatment to prevent recurrence 3, 4
• If the cyst is currently inflamed, it is preferable to postpone complete excision until inflammation has subsided 2
• For complete excision, the minimal excision technique is less invasive than complete surgical excision and does not require suture closure 2
• Ensure complete removal of the cyst wall to avoid relapses 3

Antibiotic Considerations

• Systemic antibiotics are usually unnecessary unless there are signs of systemic infection (temperature >38°C or <36°C, tachypnea >24 breaths per minute, tachycardia >90 beats per minute, or abnormal white blood cell count) 1
• The inflammation in epidermoid 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
• If antibiotics are deemed necessary, they should target Staphylococcus aureus 1

Special Considerations

• For recurrent epidermoid cysts at the same site, search for local causes such as foreign material 1
• If a mass lesion without infection signs occurs in a previously treated area, consider sonography to evaluate for recurrence or complication 5
• For suspected intraosseous epidermoid cysts (rare), MRI is recommended for any osteolytic, expanding lesion 6

Follow-up Care

• Monitor for signs of recurrence, which would indicate incomplete removal of the cyst wall 3
• If recurrent infections occur at the same site, complete excision of the cyst and its wall is necessary once 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 1
• Avoid incomplete removal of the cyst wall, which is the most common cause of recurrence 3
• Remember that epidermoid cysts are benign, with malignant transformation being extremely rare; histologic evaluation is necessary only if unusual findings or clinical suspicion of cancer is present 2