First-Line Treatment for Infected Sebaceous Cyst
Incision and drainage is the definitive first-line treatment for an infected sebaceous cyst, and systemic antibiotics are typically unnecessary unless signs of systemic infection are present. 1
Primary Management Approach
The cornerstone of treatment is incision and drainage with thorough evacuation of all purulent material. 1 This involves:
- Making an adequate incision to completely drain the cyst contents 1
- Probing the cavity to break up any loculations or septations to ensure complete drainage 1
- Covering the surgical site with a simple dry dressing after drainage 1
Do not pack the wound with gauze — studies demonstrate this causes more pain without improving healing outcomes compared to simply covering with sterile gauze. 1
When Antibiotics Are NOT Needed
Systemic antibiotics are usually unnecessary for infected sebaceous cysts because the inflammation typically results from rupture of the cyst wall and extrusion of contents into the dermis, rather than true bacterial infection. 1
Routine Gram stain and culture of pus are not recommended. 1
When Antibiotics ARE Indicated
Antibiotics should only be prescribed when signs of systemic infection are present, including: 1
- Temperature >38°C or <36°C
- Tachypnea >24 breaths per minute
- Tachycardia >90 beats per minute
- White blood cell count >12,000 or <4,000 cells/µL
- Markedly impaired host defenses
If antibiotics are necessary, they must be active against Staphylococcus aureus, the most common pathogen. 1
Critical Management Pitfalls to Avoid
- Never close the wound without adequate drainage — this leads to recurrent infection 1
- Ensure complete evacuation — if drainage is incomplete, the infection will persist or worsen; re-open the incision if needed and probe thoroughly 1
- Avoid routine antibiotic prescription — this is unnecessary in most cases and contributes to resistance 1
- Do not pack wounds unnecessarily — this increases pain without benefit 1
Follow-Up Considerations
For recurrent infections at the same site, search for local causes such as foreign material and consider complete excision of the cyst wall once acute inflammation resolves. 1