Inflamed sebaceous cysts: Sebaceous Cysts | Johns Hopkins Medicine
I have a large sebaceous cyst – should I be worried?
Author: Dr. Bobby Buka
Sebaceous cysts, by definition, are not malignant and have zero malignant potential. However, they can become infected if bacteria gets trapped within this sack of dead skin.
Normally, sebaceous cysts are asymptomatic. If the cyst partially ruptures, and dead skin ends up in the surrounding tissue, a foreign body reaction can result. This looks like a red, lump of skin and can be very tender. As mentioned earlier, if bacteria gets into this closed space or sac, an abscess can result that may be very tender and often requires drainage.
Removing sebaceous cysts is quite simple. We numb up the skin in the area, nick the top of the skin with a small blade and remove the entire cyst sac outside of the skin.
What are sebaceous cysts?
“Sebaceous cysts” are one of the most common skin conditions that we treat in dermatology. Patients notice lumps underneath their skin that may be smaller than a centimeter, but occasionally can be much larger. They feel semi-firm and are usually skin colored. Classically, we are able to see a small ‘dot’ somewhere on the lump, which is a clue that it is a “sebaceous cyst” rather than another type of lump.
The term “sebaceous cyst” is actually an inaccurate name that has kind of just stuck over time. This name suggests that the cyst is made up of oily secretions from the sebaceous glands, when in actual fact, the cyst actually contains layers of ‘keratin’, a protein that is part of our skin and hair follicles. The more appropriate medical name for them is therefore ‘epidermoid cysts’.
What causes sebaceous (epidermoid) cysts?
Epidermoid cysts occur when there is disruption in the upper layer of a hair follicle. In normal circumstances, a hair follicle opens up onto the surface of the skin without interruption. In an epidermoid cyst, a disruption to this hair follicle causes a blockage at the opening of the follicle, and therefore a build up of the normal skin/hair keratin to form behind it. This means that epidermoid cysts do not form on areas without hair follicles e.g. palms of the hands and soles of the feet.
Are sebaceous (epidermoid) cysts dangerous?
They are not dangerous in the majority of cases. Most of the time, these blockages of the hair follicles don’t even cause symptoms and patients simply notice a lump. Occasionally, when these cysts rupture underneath the skin, the keratin inside them leaks into the surrounding tissue and causes inflammation. In this case, they can become painful/red.
Also, bacteria can occasionally get inside the cyst and cause an infection. This would also result in some pain, redness and inflammation being visible on the skin.
The lumps caused by true epidermoid cysts are not a type of skin cancer, and do not become cancer other than in exceptionally rare circumstances.
How do you remove a sebaceous (epidermoid) cyst?
There are multiple options available to treat epidermoid cysts, but cutting the entire cyst out using a small surgery has the highest rates of curing the problem without it coming back. This involves numbing the area using a numbing injection, followed by a small cut with a blade. We then remove the entire cyst with the lining to make sure that the lump doesn’t simply re-form, and then close the skin using stitches.
When the cyst is very inflamed or we are concerned for infection, we often treat patients with a course of antibiotic tablets to help bring down the redness and inflammation before doing a full surgery to cut out the cyst. This is because the surgery is easier to do and results in better healing often when the cyst is not red and inflamed.
Other treatment options include injecting the cyst with a steroid solution, and also making a small cut in the skin and squeezing out some of the cyst contents. Both of these can help to reduce inflammation and the size of the cyst, but because they don’t remove the wall of the cyst (where the proteins come from), the cyst can often form again within months to years. They are a good option for people who don’t want surgery with stitches, but just a short to medium term fix for the problem.
What else could the lump be?
Although epidermoid cysts are a very common cause of lumps in the skin, there are other conditions that can present in a very similar way. Under the skin lumps can occasionally be caused by other types of hair follicle cysts, or also be collections of fat cells known as ‘lipomas’. The best way to figure out which type of cyst you may have is by being evaluated by a dermatologist. We can identify where your cyst is (different types of cyst are more common in different locations), what it looks like under magnification (does it have a hair follicle visible which can be a clue to an epidermoid cyst), is it moveable (this can be more typical of a lipoma), and many others aspects. Also, if we remove the cyst with a surgery, we send this to the lab to get a definite diagnosis and provide you peace of mind.
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Sebaceous cysts are white or yellow lumps on the skin. They’re fairly rare, and they’re usually not cancerous. Epidermal inclusion cysts or epidermoid cysts are sometimes confused with sebaceous cysts. But they’re different from sebaceous cysts, because epidermal inclusion cysts and epidermoid cysts are related to skin cells. Sebaceous cysts involve the sebaceous glands.
The sebaceous glands secrete oil and other fats that lubricate the hair and skin. Eating fats or oils does not make your sebaceous glands produce more oil or increase the risk of getting a sebaceous cyst.
Sebaceous cysts can be found on your entire body – even inside your mouth or on the genitals – but they won’t appear on your palms or soles of your feet.
Sebaceous cyst symptoms & causes
The main symptom of a sebaceous cyst is a lump under the skin. Most sebaceous cysts are harmless, rarely need treatment and sometimes even go away on their own. See your doctor if you have a skin lump that shows any of these signs:
- Warmth, redness, pain or swelling (could indicate an infection)
- Rapid growth
- Constant irritation
- Location on a finger or toe
What causes sebaceous cysts?
Sebaceous cysts can develop if the sebaceous glands get damaged or blocked. This usually happens from some sort of trauma like a scratch, a surgical wound or a skin condition like acne.
Diagnosis of sebaceous cysts
Sebaceous cysts are much less common than epidermoid cysts or epidermal inclusion cysts. Although your doctor can usually tell if you have a sebaceous cyst by its slightly yellowish color, they can only confirm the diagnosis after studying what’s inside.
Testing for sebaceous cysts
Sebaceous cysts are rarely cancerous. But if your doctor suspects your cyst is abnormal and possibly cancerous, they may order the following tests:
- Ultrasound imaging to see what’s inside the cyst
- A punch biopsy to remove a small amount of tissue from the cyst and test it for cancer
- A CT scan if your doctor thinks you may need surgery to remove the sebaceous cyst
Sebaceous cyst treatment
If a small sebaceous cyst becomes enlarged and inflamed, your health care provider may inject it with a steroid drug to reduce swelling. Another sebaceous cyst treatment option is to drain the cyst. If your doctor believes a sebaceous cyst is infected, you might need antibiotic medication.
Removing sebaceous cysts
A sebaceous cyst may need to be removed if it causes hair loss on the scalp or interferes with clothing. You also may want your doctor to remove a sebaceous cyst for cosmetic reasons.
When cyst removal is the best treatment option, you’ll be given a local anesthetic to numb your skin. If the entire cyst is removed, it’s unlikely to come back.
Treatment for cysts/cyst removal methods:
- Laser-aided excision: The sebaceous cyst is drained when a laser makes a small hole in it.
- Conventional wide excision: Your health care provider will make a cut and squeeze out the contents. This procedure leaves a long scar after the sebaceous cyst is removed.
- Minimal excision: The sebaceous cyst is removed using a smaller cut.
- Punch excision: The sebaceous cyst and a small area of normal skin around it are removed using a scalpel that looks like a small cookie cutter.
Skin health tips
Be sure to contact your doctor if you see anything wrong with your skin. A lump you find might be a harmless, benign sebaceous cyst, or it could be something more serious. See your Aurora provider for a clear diagnosis and correct treatment options.
Don’t try to burst and drain cysts yourself. This could spread an infection, and the cyst could grow back.
Find a dermatologist
Aurora Health Care operates dermatology clinics in Milwaukee, Waukesha, Greenfield, Sheboygan, and throughout eastern Wisconsin and northern Illinois. If you think you may have sebaceous cysts, find a dermatologist near you.
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Atheroma: symptoms, treatment and removal
Atheroma is a cyst of the sebaceous gland resulting from blockage of its duct, a domed protrusion under the skin filled with keratin, a protein component found in hair, nails and skin.
90% of atheromas are formed on the scalp, the formation of any localization (on the back, chest, in the groin) is possible, except for the palms and soles. In about 30% of cases, a single cyst occurs, in 70% of cases, multiple neoplasms. The prevalence of the disease is low: 5–10% of the population.
Atheromas are often confused with epidermal cysts, this is not true, since epidermal cysts are not filled with keratin and its decay products, but with keratinized cells of the epidermis.
Sebaceous cyst is a benign neoplasm. Malignant transformation is very rare.
Atheromas grow slowly, rapid cyst growth may be a sign of infection or malignancy.
Atheromas most often occur sporadically due to a violation of the outflow of sebaceous gland secretion associated with hormonal changes, structural features of the sebaceous glands, mechanical damage to the skin, but can be inherited (autosomal dominant type). The clinical criterion indicating the second option is the presence of such cysts in 2 or more relatives of the first or second degree of kinship. The formation of atheromas usually affects middle-aged people, most often women. Patients with a family history of atheromas are more likely to be diagnosed at a younger age and are characterized by multiple neoplasms.
The growth of atheroma is usually asymptomatic, it does not cause discomfort to the patient, except for cosmetic. However, the cyst can calcify, become inflamed due to infection (for example, if the skin is damaged during scratching), festering atheroma can rupture on its own.
Diagnosis of atheroma is based on signs and symptoms. Imaging diagnostic methods (ultrasound, MRI, CT) are not always required. Basically, they are aimed at differentiating with similar neoplasms and determining the degree of germination of the cyst into soft tissues.
Differential diagnosis is carried out with the following diseases: keloid acne, lipoma, epidermal cyst, dermoid cyst, Favre-Rakusho disease, pilomatrixoma, multiple steatocystoma.
Treatment of atheroma
Treatment of atheroma surgically, at the request of the patient. The cyst is removed completely, with a capsule, to eliminate the risk of recurrence. Subsequent histopathological evaluation confirms the diagnosis. Inflamed (festering) cysts are not operated on, they are waiting for the effect of conservative treatment aimed at stopping inflammation. In rare cases of malignant transformation of atheroma, radiation therapy and chemotherapy are used.
Surgical treatment of atheroma has a positive prognosis.
Benefits of atheroma treatment at the Rassvet Clinic
Dermatologists of Rassvet will determine the cause of atheroma, carry out the necessary diagnostics and treatment based on the most modern standards, international recommendations and protocols. The decision on the treatment of atheroma is made by our doctors only together with the patient, taking into account his preferences. If necessary, they are referred for consultation with doctors of related specialties.
- Daifallah M. Al Aboud, TAIF University, Siva Naga S. Yarrarapu, Monmouth Medical Center, Bhupendra C. Patel, University of Utah, National Center for Biotechnology Information, U.S. National Library of Medicine: Pilar Cyst // Last updated: August 27, 2021 / https://www.ncbi.nlm.nih.gov/books/NBK534209/
- Anila Kapadia, Dermatology Registrar, York Teaching Hospital NHS Foundation Trust, United Kingdom, DermNet New Zealand Trust: Trichilemmal cyst // https://dermnetnz.org/topics/trichilemmal-cyst
- Anne Elizabeth Laumann, MBChB, MRCP(UK), FAAD Professor Emerita of Dermatology, Northwestern University, The Feinberg School of Medicine, Medscape: Trichilemmal Cyst (Pilar Cyst) // Updated: Jun 11, 2020 / https://emedicine. medscape.com/article/1058907-overview
- Warren R. Heymann, MD, American Academy of Dermatology Association: Incysting on understanding pilar cysts // https://www. aad.org/dw/dw-insights-and-inquiries/2020-archive/july/incysting-on -understanding-pilar-cysts/
- Skinsight: Pilar Cyst // Last updated on 11/23/2016 / https://www.skinsight.com/skin-conditions/adult/pilar-cyst
Amelicheva Alena Aleksandrovna
Publication date: 10 December 2021
Update date: 14 February 2023
Atheroma. What is Atheroma?
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
Atheroma is a cyst of the sebaceous gland, which is a cavity filled with a mushy secret. It has the appearance of a subcutaneously located, rounded, uplifting formation of a soft-elastic consistency. Atheroma is easily displaced relative to the underlying tissues and slowly increases in volume, sometimes reaching 7-10 cm in diameter. The diagnosis is based on data from a general examination, ultrasound, histological examination. Surgical treatment involves the removal of the formation along with the capsule that forms it, which eliminates the possibility of recurrence. On the face, removal of cysts by the method of cystotomy is allowed to reduce the severity of postoperative scars.
D23 Other benign skin neoplasms
- Causes of atheroma
- Atheroma symptoms
- Atheroma treatment
- Prognosis and prevention
- Prices for treatment
In the scientific literature, the pathological formation has a number of synonymous names: epidermoid or epidermal cyst, trichodermal cyst, epidermoid, steatocytoma, retention cyst. In everyday life, education is referred to as a “wen”. Multiple neoplasms are called skin atheromatosis. There are epidermoid cysts, according to various sources, in 5-10% of the population, and in women twice as often as in men. The most characteristic age for the formation of atheromas is 20-30 years. However, as a rule, patients seek medical help after a few years, when the formation reaches a significant size and becomes a noticeable cosmetic defect.
Causes of atheroma
The main factor in the formation of retention cysts is the formation of an obstacle or a significant difficulty in the outflow of the secretion of the sebaceous gland against the background of the ongoing production of sebum. The causes of outflow disturbance are diverse, often combined and mutually reinforcing each other’s action. The main mechanisms for the formation of atheromas include:
- Structural features of skin glands. Pathological changes in the structure of the sebaceous glands occur at the stage of embryonic development and are caused by genetic defects. The accumulation of secretion in the sebaceous glands, which do not have an excretory duct, begins in utero. In these cases, the first atheromas are diagnosed in a child immediately after birth.
- Changing the nature and amount of the secret. An increase in the viscosity of sebum against the background of an increase in the process of keratinization of the mouths of the ducts of the sebaceous glands leads to the formation of sebaceous plugs. This process is based on hormonal and psychogenic factors that contribute to the development of severe acne, oily seborrhea, hyperhidrosis. These diseases are often the background against which atheromas develop.
- Mechanical damage to the skin. The process of scarring and epithelialization of the skin wound leads to narrowing or blockage of the duct of the sebaceous gland. Atheromas appear in places of healed cuts, scratches and abrasions, permanent removal of unwanted hair. Often, retention cysts begin to grow at the site of opened and healed boils, drain abscesses.
- Adverse external influences. The probability of occurrence of atheromas is higher in persons exposed to radioactive irradiation, the action of ultraviolet radiation. The growth of sebaceous cysts can provoke frostbite and burns. This is supported by the fact that retention cysts often appear on open areas of the body, head and neck.
In the clogged sebaceous gland, secretion continues to be produced. The content accumulates and begins to put pressure on the walls of the cavity, gradually stretching them. An increase in the volume of the gland does not cause discomfort, itching or pain, since there is no compression of the nerve endings. The skin above the growing cyst rises, a rounded seal of soft-elastic consistency is formed. The blood circulation in the area of the atheroma does not change, since the volume of living tissues of the dermoid practically does not increase. Integuments over the formation of the usual color.
Gradually, a connective tissue capsule begins to form around the walls of the overstretched sebaceous gland. The inner surface of the cyst walls constantly produces a secret. Puncture and emptying of the cavity does not lead to recovery. The puncture site heals, and the cavity again begins to fill with a liquid fatty secret. To avoid recurrences, peeling of the dermoid together with the capsule allows.
Atheromas are divided into groups according to the histological structure and causes of appearance. Differences in the cellular structure of cysts do not manifest themselves clinically, therefore the histological classification is of interest only to researchers. In practical dermatology, a classification based on the features of the formation of atheromas is important. According to her, cysts from the sebaceous glands are divided into two groups:
- Congenital (primary or true). At the heart of their development is a genetic defect that affects the formation of the sebaceous glands and their ducts. The development of cysts from skin anlages begins in utero, therefore congenital atheromas are often detected in newborns. They are rarely larger than 0.5 cm. Usually, the formations are multiple.
- Acquired (secondary or false). They develop in unchanged sebaceous glands when their lumen is blocked. They appear mainly in adult patients against the background of previous skin lesions, existing disorders of the activity of the sebaceous glands. For a long time, they increase in volume, reaching significant sizes. Represented by single formations.
Retention cysts can develop on any part of the head, body and limbs where there are sebaceous glands, regardless of whether the ducts of the glands open to the surface of the skin or to the mouths of the hair follicles. In fact, this is any anatomical region, including the armpits and popliteal fossae, with the exception of the palms and feet. False atheromas are more common on the head, neck, upper third of the back, face. A characteristic localization of true atheromas is the perineal region.
Outwardly, the cyst has the appearance of a rounded formation, slightly lifting the skin. To the touch, atheroma is soft, large cysts fluctuate noticeably on palpation due to the liquid content. A blocked excretory duct may be visible on the surface of the cyst. The formation is easily displaced along with the skin relative to the deeper tissues. The skin over the atheroma is not taken into a fold. The average size of atheroma is 1-2 cm, but there are tumors up to 10 cm in diameter. The growth of the formation is not accompanied by unpleasant sensations, except when the cyst is subjected to constant mechanical irritation when rubbed with clothes or combed.
On the scalp, atheromas are single and multiple. Trichodermal cysts reach sizes of 5 cm or more. On the skin that covers them, the hair often thins or falls out completely. Characterized by ulceration, bleeding, necrosis of surrounding tissues. In patients suffering from oily seborrhea, atheromas located on the head, face and neck can thicken significantly over time, the skin over them acquires a bluish tint, and pain is noted when pressed.
The most common complication of atheroma is its suppuration. Accession of infection leads to the development of an inflammatory reaction, a violation of the general condition, hyperthermia. This condition requires urgent medical attention.
Abscessing atheroma is also dangerous in cases where they try to squeeze out its contents or restore the patency of the duct mechanically. Normally, the capsule surrounding the cyst helps to limit the purulent-inflammatory process. Mechanical impact can destroy this barrier. The unhindered spread of pyogenic bacteria in tissues leads to phlegmon, their entry into the bloodstream leads to sepsis.
The clinical picture of most benign neoplasms of the skin and subcutaneous tissue is largely similar. The dermatologist at the appointment is faced with the task of conducting a differential diagnosis, determining the type of pathological formation, and choosing the most effective method of treatment. For this, the following is carried out:
- General inspection. On palpation, signs of a cavity formation with clear boundaries associated with the skin are determined. For diagnosis, the slow growth of the sebaceous cyst, the presence of a clogged gland opening on its surface is important. If there are signs of inflammation or mechanical irritation of the cyst, it is recommended to remove the formation in the near future.
- Ultrasound. It is carried out in difficult diagnostic cases. Ultrasound of soft tissues allows visualization of the capsule and the cavity filled with liquid contents. These data help to diagnose atheroma with 100% certainty. The study is informative for the differentiation of the epidermoid from lipoma (benign tumor of adipose tissue), fibroma (connective tissue node), hygroma (neoplasm of the sweat gland).
- Morphological diagnostics. Rapid diagnosis of the cellular composition of the neoplasm can be performed during surgery. It is also possible to conduct a histological examination after removal of the cyst in order to confirm the diagnosis and exclude the malignant nature of the tumor.
Approaches to the treatment of epidermal cysts in dermatology and outpatient surgery differ significantly. They are not mutually exclusive and can be effective in different clinical situations, since it is important not only to remove the neoplasm, but to choose treatment and care procedures in order to normalize the production of sebum and prevent the appearance of new atheromas.
- Conservative treatment. It is prescribed at the stage of preparation for surgery, when it is necessary to stop inflammation. Ointments with anti-inflammatory and antibacterial components are used. In the postoperative period, in order to prevent the formation of new atheromas, the patient is selected drugs and cosmetics for daily care that normalize the functioning of the sebaceous glands.
- Cystectomy. The classic surgical operation for atheroma without signs of inflammation involves exfoliation of the formation with a capsule through a small skin incision. Also, good results are obtained by evaporating the capsule with a laser, a radio wave method for removing atheroma.
- Removal of a festering cyst. Abscessing atheroma is removed in two stages. At the first stage, the festering atheroma is opened: the contents of the cyst are evacuated through the incision, the cavity is washed with antiseptic solutions, and local anti-inflammatory treatment is prescribed. On the second, after the inflammatory process subsides, the capsule is removed.
- Cystotomy. On the face, the preferred method for removing cysts is their puncture, emptying, creating conditions for tissue healing without suturing. After cystotomy, a round-shaped atrophic scar with a diameter of up to 4 mm remains at the site of the formed hole, which is not regarded by patients as a cosmetic defect.
Prognosis and prevention
To prevent the development of atheromas, a timely appeal to a dermatologist and cosmetologist about any changes in the condition of the skin and hair allows. Youthful acne, seborrhea, increased oiliness of the skin are conditions that require correction and constant, properly selected supportive treatment. With already developed atheromatosis, an examination of the hormonal background, correction of the identified violations is indicated. It is advisable to abandon traumatic methods of hair removal (waxing, sugaring) in favor of laser hair removal, reduce the time spent in the sun and in the solarium.
You can share your medical history, what helped you in the treatment of atheroma.
- Reference book of a dermatologist / Ivanov O. L., Lvov A. N. – 2012. / Health. Medical ecology. The science. – 2014.
- Results of surgical treatment of facial atheromas using a sparing method (cystotomy)/ Grigoryeva TS// Medical news.