From the Guidelines
Sebaceous cysts, often mistakenly referred to as epidermoid cysts, should be treated with incision, thorough evacuation of the pus, and probing the cavity to break up loculations when inflamed, as this approach is effective in managing 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, epidermoid cysts, which are often erroneously labeled as sebaceous cysts, contain skin flora in the cheesy keratinous material, even when uninflamed.
When considering treatment options, it's essential to note that:
- Incision and drainage can be effective for inflamed cysts
- Systemic antibiotics are rarely necessary, except in cases of multiple lesions, cutaneous gangrene, severely impaired host defenses, extensive surrounding cellulitis, or severe systemic manifestations of infection
- Gram stain, culture, and systemic antibiotics are not typically required for the treatment of sebaceous cysts
- Simply covering the surgical site with a dry dressing is usually the easiest and most effective treatment of the wound
It's crucial to approach the treatment of sebaceous cysts with caution, avoiding unnecessary interventions and focusing on effective management of inflamed cysts, as outlined in the guidelines 1.
From the Research
Treatment Options for Sebaceous Cysts
- Traditional surgical excision can completely eradicate the cyst, but may cause obvious scarring 2
- CO2 laser punch-assisted minimally invasive surgery is a simple treatment method that prevents the formation of conspicuous scars 2
- One-stage excision of inflamed sebaceous cysts can decrease the duration of antibiotic exposure, reduce morbidity, and is more economical compared to conventional treatment 3
- A new procedure involving removal of the cyst content with a laser punch and the cyst wall with a minimal postponed excision can completely remove the cyst with only a small scar 4
Advantages and Disadvantages of Treatment Options
- CO2 laser punch-assisted surgery has minimal scarring and high patient satisfaction, but may have a recurrence rate of 6.0% 2
- One-stage excision of inflamed sebaceous cysts has advantages over conventional treatment, but requires appropriate case selection 3
- The new procedure proposed in 4 offers a good alternative for eradication of uninfected cysts, especially large cysts or cysts located in areas of thick skin or cosmetic concern
Surgical Procedures and Outcomes
- CO2 laser punch-assisted surgery involves pre-separating the cyst wall from surrounding tissues, removing the cyst contents through a small hole, and removing the cyst wall using a hemostat 2
- One-stage excision of inflamed sebaceous cysts involves primary resection of the cyst followed by antibiotic administration 3
- The new procedure involves removal of the cyst content with a laser punch and the cyst wall with a minimal postponed excision 4