From the Guidelines
Sebaceous cysts, more accurately referred to as epidermoid cysts, are best managed through incision, thorough evacuation of the contents, and probing the cavity to break up loculations when they become inflamed or infected, as this approach is effective in treating the condition without the need for systemic antibiotics in most cases. According to the practice guidelines for the diagnosis and management of skin and soft-tissue infections 1, the treatment of inflamed epidermoid cysts (often mistakenly called sebaceous cysts) involves surgical intervention to drain the cyst. This method is preferred because it directly addresses the cause of the inflammation, which is often a reaction to the rupture of the cyst wall and the extrusion of its contents into the dermis, rather than an infectious complication.
Key points to consider in the management of sebaceous (epidermoid) cysts include:
- Observation for asymptomatic cysts, as many remain stable and cause no problems.
- Warm compresses and oral antibiotics for infected cysts, although the use of antibiotics should be judicious and based on the severity of the infection and the patient's overall health status.
- Complete surgical excision for definitive treatment, especially for recurrent or problematic cysts, to prevent recurrence by removing the entire cyst wall.
- Avoidance of incision and drainage for non-infected cysts, as this can lead to recurrence by leaving the cyst wall intact.
It's also important to note that while systemic antibiotics, such as those mentioned in other contexts, might be considered in certain cases of infection, the guidelines suggest that Gram stain, culture, and systemic antibiotics are rarely necessary for the treatment of cutaneous abscesses or inflamed epidermoid cysts 1. The focus should be on effective surgical drainage and management of the cyst to prevent complications and promote healing.
From the Research
Management of Sebaceous Cysts
- The management of sebaceous cysts can be done through various methods, including incision and drainage, excision, and laser treatment 2, 3, 4.
- For infected sebaceous cysts, a study found that excising the infected tissue along with a rim of healthy tissue and closing the wound with stitches can lead to quick recovery and minimal risk of cross-infection 2.
- Another method involves using a laser to remove the cyst content and then excising the cyst wall with a minimal postponed excision, resulting in a small scar 3.
- A technique involving minimal surgical trauma and good cosmetic results has also been described, with a low recurrence rate of 0.66% in a series of 302 patients 4.
- In terms of perioperative care, the use of oral antibiotic prophylaxis is not recommended for routine use, and alternatives such as wound antisepsis may be considered to reduce infection risk 5.
- The choice of management method may depend on the size and location of the cyst, as well as the patient's overall health and cosmetic concerns 3, 4.