What is the recommended antibiotic treatment for an infected sebaceous cyst on the nose?

Management of Infected Sebaceous Cyst on the Nose

For an infected sebaceous cyst on the nose, incision and drainage is the primary treatment, with antibiotics only needed if there is extensive surrounding cellulitis or systemic signs of infection. When antibiotics are required, doxycycline or trimethoprim-sulfamethoxazole are recommended for empiric coverage of MRSA.

Initial Management

• The most effective treatment for an infected sebaceous cyst is thorough evacuation of pus through incision and drainage, followed by probing the cavity to break up loculations and covering with a dry dressing 1
• Incision and drainage alone is typically sufficient for localized infections without systemic involvement 1
• Surgical excision of the entire cyst along with the rim of healthy tissue may be performed in the same sitting to prevent recurrence 2

When Antibiotics Are Indicated

• Systemic antibiotics should be reserved for cases with:
  • Extensive surrounding cellulitis
  • Systemic signs of infection (fever, chills)
  • Severely impaired host defenses
  • Multiple lesions or cutaneous gangrene 1, 3

Antibiotic Selection

• When antibiotics are necessary, the following are recommended:

  • Doxycycline (100 mg twice daily) is a first-line option for coverage of MRSA 3
  • Trimethoprim-sulfamethoxazole is an effective alternative, particularly for MRSA coverage 3
  • Clindamycin may be used if the patient cannot tolerate the above options 3

• For patients with extensive infection or at risk of polymicrobial infection:

  • Consider broader coverage with amoxicillin-clavulanate 3
  • Cephalexin (500 mg four times daily) may be used if MRSA is not suspected 4, 5

Special Considerations for Facial Lesions

• Facial infections, particularly those in the "danger triangle" of the face (including the nose), require prompt attention due to risk of spread to intracranial structures 3
• The nose area has rich vasculature that can facilitate spread of infection, so monitor closely for signs of progression 3
• Empiric antibiotic therapy should be initiated promptly if there are signs of spreading infection from a nasal sebaceous cyst 3

Duration of Treatment

• When antibiotics are indicated, a 7-10 day course is typically recommended 3
• Shorter courses (5-7 days) may be sufficient if the infection responds quickly to drainage and antibiotics 6

Follow-up Care

• Return for follow-up in 3-5 days if there is:
  • Recurrent discharge
  • Poor wound healing
  • Progressive induration
  • Crepitus
  • Fluctuance
  • Development of systemic symptoms 1

Cautions

• Overuse of antibiotics contributes to antimicrobial resistance and should be avoided when incision and drainage alone is sufficient 1
• One study showed that antibiotics may be unnecessary after surgical drainage of uncomplicated skin abscesses, with cure rates of 90.5% in placebo groups 4
• Rarely, what appears to be an infected sebaceous cyst could be a more serious condition, so biopsy should be considered if the lesion does not respond to standard treatment 7