What is a sebaceous cyst and how is it properly removed in a child?

What is a Sebaceous Cyst?

A sebaceous cyst (more correctly called an epidermoid cyst) is like a small balloon under your skin filled with a thick, cheesy material that looks like cottage cheese. 1, 2 Think of it as a tiny bag that got trapped under your skin when you were growing, and it slowly fills up with dead skin cells and other stuff your body makes. 2

Why Does It Happen?

Your skin is always making new cells and getting rid of old ones. Sometimes, a little pocket forms under the skin and traps these old cells inside instead of letting them come out. 1 Over time, this pocket fills up and makes a bump you can feel. 2

What Does It Look Like?

• A round bump under the skin that you can move around a little bit, like a marble under a blanket 1
• Often has a tiny dark dot in the center (like a small freckle) where the pocket connects to the surface 3
• Usually doesn't hurt unless it gets irritated or infected 2
• Most common on the head, neck, back, or face 4

How Do Doctors Remove It Properly?

When It's NOT Infected (The Regular Way)

The best way to remove a sebaceous cyst is to take out the entire cyst wall (the balloon part) so it doesn't come back. 4, 5 Here's how doctors do it:

1. Numb the area with medicine so you don't feel anything 6

2. Make a small cut in the skin over the bump 4, 5

3. Carefully remove the entire cyst including the wall/bag part - this is super important! 4 If they leave any of the wall behind, the cyst can grow back 4

4. Close the cut with stitches 6, 4

5. Remove stitches after 1-3 weeks depending on where it is on your body 6

The recurrence rate with proper complete removal is extremely low (less than 1%) when the entire cyst wall is removed. 4

When It's Infected or Inflamed (The Trickier Situation)

Sometimes the cyst gets red, swollen, and painful because the bag breaks open inside and irritates the surrounding skin. 3, 2 This inflammation usually happens from the cyst wall rupturing, not from germs getting in. 1, 3

When this happens, doctors have two main approaches:

Option 1: Drain it first, remove it later 3, 2

• Cut it open and let the thick material drain out 3
• Let it heal for a few weeks 5
• Come back later to remove the cyst wall completely 5

Option 2: Remove everything at once 6

• Cut out the infected cyst AND the wall in one surgery 6
• Close it with stitches right away 6
• This newer approach works well and patients heal quickly 6

Do You Need Antibiotics (Germ Medicine)?

Usually NO! 3 Most inflamed cysts don't need antibiotics because the inflammation isn't caused by an infection with germs. 1, 3

You DO need antibiotics if: 3

• You have a fever over 101.3°F 3
• The redness spreads more than 2 inches from the bump 3
• Your heart is beating really fast 3
• You have other health problems that make it hard to fight infections 3

Important Things to Remember

• The cyst wall MUST come out or the cyst will probably come back 4
• It's not usually caused by germs, so antibiotics often aren't needed 1, 3
• Just draining it without removing the wall means it will likely fill back up 3
• The scar is usually very small when done properly 4, 5

When to Worry

See a doctor right away if: 1

• The bump grows really fast 1
• It becomes very hard or stuck to the skin underneath 1
• It won't heal or keeps coming back in the same spot 1
• You're an adult and it's on your eyelid and won't go away 1

These could be signs of something more serious that needs to be checked. 1