What are the treatment options for sebaceous cysts?

Treatment Options for Sebaceous Cysts

Surgical excision is the primary treatment for sebaceous cysts, with complete removal of the cyst wall being essential to prevent recurrence. 1, 2

Diagnosis and Assessment

• Sebaceous cysts are benign encapsulated, subepidermal nodules filled with keratin material, commonly found in areas with body hair such as the scalp, face, neck, back, and scrotum 3
• Differentiate sebaceous cysts from other conditions including abscesses, which contain pus rather than the cheesy keratinous material found in sebaceous cysts 1
• Inflammation and purulence in cysts typically occur as a reaction to rupture of the cyst wall and extrusion of contents into the dermis, rather than as a primary infectious complication 1

Treatment Options

1. Surgical Excision (Primary Treatment)

• Complete excision with a narrow rim (2 mm) of normal skin is the standard practice for definitive treatment 2
• The incision should be elliptical with the long axis parallel to the skin lines for optimal cosmetic results 2
• Tissue should be removed using a scalpel rather than laser or electrocautery to preserve histological features 2
• All excised tissue should be sent for histopathological examination to rule out malignancy 2
• Minimal-incision techniques have shown low recurrence rates (0.66%) with good cosmetic results 4

2. Management of Infected Sebaceous Cysts

• For infected cysts, two approaches exist:
  • One-stage excision: Complete removal of the inflamed cyst followed by antibiotic therapy (5 days) 5
  • Conventional two-stage approach: Initial incision and drainage with antibiotics, followed by elective excision 1-2 months later when inflammation has subsided 5
• Research suggests one-stage excision decreases antibiotic exposure duration, reduces morbidity, and is more economical 5
• Some surgeons use suture closure after excising infected cysts, which can promote quicker recovery and reduce the need for frequent dressing changes 6

3. Special Techniques for Cosmetically Sensitive Areas

• For cysts in cosmetically sensitive areas like the face (lips or cheek near lip commissure), an intraoral approach can be used to avoid visible scarring 7
• This involves making an intraoral incision and performing blunt dissection through the buccinator or orbicularis oris muscle until the cyst wall is reached 7

4. Post-Procedure Care

• Simply covering the surgical site with a dry dressing is usually sufficient for wound management 2
• Some clinicians may pack the wound with gauze or suture it closed depending on the specific case 2
• Stitches are typically removed on the 21st day for cysts on the back and 14th day for cysts on limbs 6

Indications for Hospital Admission

• Hospital admission should be considered if the patient presents with signs of systemic toxicity (fever, tachycardia, tachypnea, hypotension) 2
• Extensive surrounding cellulitis indicating spreading infection 2
• Severely impaired host defenses that may complicate healing 2
• Multiple lesions with severe systemic manifestations of infection 2

Caveats and Special Considerations

• Recurrence is common if the cyst wall is not completely removed 1, 4
• For multiple sebaceous cysts covering large areas (e.g., scrotum), complete removal of all cysts may be necessary 3
• Always consider the possibility of malignancy, particularly in long-standing or rapidly growing cysts 2
• Sebaceous cysts on the face require special attention due to cosmetic considerations and should be approached with techniques that minimize scarring 7