What are sebaceous cysts and how do they form. Are sebaceous cysts dangerous or cancerous. How are sebaceous cysts diagnosed and treated. What are the potential complications of sebaceous cysts. When should you see a doctor for a sebaceous cyst.

Understanding Sebaceous Cysts: An In-Depth Look

Sebaceous cysts, more accurately termed epidermoid cysts, are common skin conditions that often perplex those who discover them. These benign growths can appear anywhere on the body where hair follicles are present, causing concern for many individuals. To shed light on this topic, let’s explore the nature of these cysts, their causes, and available treatment options.

What Are Sebaceous Cysts and How Do They Form?

Despite their common name, sebaceous cysts are not actually related to sebaceous glands. Instead, they are typically epidermoid cysts, which form when the top layer of skin (epidermis) grows deeper into the skin rather than shedding normally. This results in a sac filled with keratin, a protein that’s a major component of skin and hair.

How do these cysts develop? The process begins with a disruption in the upper layer of a hair follicle. Normally, hair follicles open onto the skin’s surface without interruption. However, when this opening becomes blocked, it leads to a buildup of keratin behind the blockage. This accumulation forms the characteristic lump we recognize as a cyst.

Identifying Sebaceous Cysts

Sebaceous cysts present as small, round bumps under the skin. They can vary in size, ranging from less than a centimeter to several centimeters in diameter. These cysts are typically:

• Slow-growing and painless
• Movable when touched
• Skin-colored or slightly yellowish
• Often featuring a small, dark “punctum” or opening on the surface

The Misconception of “Sebaceous” Cysts

Why are these growths often mislabeled as “sebaceous” cysts? This misnomer has persisted over time, likely due to a historical misunderstanding of their origin. The term suggests that these cysts are filled with oily secretions from sebaceous glands. However, true sebaceous cysts are relatively rare and arise from sebaceous glands themselves, not hair follicles.

In reality, what most people refer to as sebaceous cysts are epidermoid cysts. These cysts contain keratin, not sebum, and are formed by the epidermis rather than sebaceous glands. This distinction is important for proper diagnosis and treatment.

Causes and Risk Factors for Epidermoid Cysts

What leads to the formation of epidermoid cysts? Several factors can contribute to their development:

1. Trauma or injury to the skin
2. Blockage of hair follicles
3. Genetic predisposition
4. Certain skin conditions, such as acne
5. Hormonal changes

Can epidermoid cysts be prevented? While it’s not always possible to prevent these cysts, maintaining good skin hygiene and avoiding picking or squeezing existing bumps can help reduce the risk of their formation or complications.

Are Sebaceous Cysts Dangerous or Cancerous?

One of the most common concerns regarding sebaceous cysts is their potential for malignancy. Are these growths dangerous? In the vast majority of cases, epidermoid cysts are completely benign. They have no malignant potential and do not transform into skin cancer.

However, while not dangerous in themselves, epidermoid cysts can lead to complications if they become infected or rupture. In rare cases, a type of skin cancer called squamous cell carcinoma can develop within an epidermoid cyst, but this is extremely uncommon.

Potential Complications of Epidermoid Cysts

Although generally harmless, epidermoid cysts can sometimes cause problems:

• Infection: If bacteria enter the cyst, it can become infected, leading to pain, redness, and swelling.
• Rupture: A ruptured cyst can release its contents into surrounding tissues, causing inflammation and discomfort.
• Cosmetic concerns: Large or prominent cysts may cause self-consciousness or affect appearance.

Diagnosis and Medical Evaluation of Sebaceous Cysts

How are sebaceous cysts diagnosed? In most cases, a dermatologist can diagnose an epidermoid cyst through visual examination and physical palpation. The characteristic appearance and feel of these cysts often make diagnosis straightforward. However, in some instances, additional tests may be necessary:

• Ultrasound imaging: This can help differentiate between cysts and other types of growths.
• Biopsy: In rare cases where malignancy is suspected, a small sample of the cyst may be removed for microscopic examination.
• CT or MRI scans: These might be used if the cyst is unusually large or in a complex location.

Can a doctor tell if a cyst is infected without draining it? Often, signs of infection such as redness, warmth, and tenderness can be observed externally. However, in some cases, aspiration (drawing out fluid with a needle) may be necessary to confirm infection and identify the causative organism.

Treatment Options for Sebaceous Cysts

What are the available treatments for sebaceous cysts? The approach to treating these cysts depends on various factors, including the cyst’s size, location, and whether it’s causing symptoms. Here are some common treatment options:

1. Observation

For small, asymptomatic cysts, a watch-and-wait approach may be recommended. Many cysts remain stable and don’t require intervention unless they become problematic.

2. Incision and Drainage

This procedure involves making a small cut in the cyst and draining its contents. While this can provide immediate relief, it doesn’t remove the cyst wall, so recurrence is common.

3. Complete Surgical Excision

This is the most effective treatment for preventing recurrence. The entire cyst, including its wall, is surgically removed. How is this procedure performed?

1. The area is numbed with local anesthesia.
2. A small incision is made over the cyst.
3. The entire cyst sac is carefully separated from surrounding tissue and removed.
4. The incision is closed with stitches.

4. Minimally Invasive Removal

Some dermatologists use techniques that allow for cyst removal through a smaller incision, potentially resulting in less scarring.

5. Laser Therapy

In some cases, laser treatments can be used to vaporize the cyst contents and destroy the cyst wall.

6. Corticosteroid Injections

For inflamed cysts, injecting a corticosteroid medication can reduce swelling and discomfort.

Home Remedies and Self-Care for Sebaceous Cysts

While medical treatment is often necessary for complete resolution, there are some self-care measures that can help manage sebaceous cysts:

• Warm compresses: Applying warm, moist compresses can help reduce inflammation and promote drainage.
• Gentle cleaning: Keep the area clean to prevent infection.
• Avoid squeezing or picking: This can lead to infection or scarring.
• Over-the-counter pain relievers: These can help manage discomfort from inflamed cysts.

Do natural remedies effectively treat sebaceous cysts? While some people report success with various home remedies, there’s limited scientific evidence supporting their effectiveness. It’s always best to consult a healthcare professional before attempting any alternative treatments.

When to Seek Medical Attention for a Sebaceous Cyst

While many sebaceous cysts are harmless, certain situations warrant medical evaluation. When should you see a doctor for a sebaceous cyst?

• Rapid growth or change in size
• Signs of infection (redness, warmth, pain, or pus drainage)
• Cysts in sensitive or problematic locations
• Cosmetic concerns or discomfort affecting daily activities

Is it ever an emergency? In rare cases, rapidly developing redness, severe pain, or fever could indicate a serious infection requiring immediate medical attention.

Living with Sebaceous Cysts: Long-Term Management

For individuals prone to developing sebaceous cysts, long-term management strategies can be helpful. These may include:

• Regular skin examinations to monitor existing cysts and detect new ones early
• Maintaining good skin hygiene
• Avoiding trauma or irritation to areas prone to cyst formation
• Discussing preventive measures with a dermatologist

Can sebaceous cysts be prevented from recurring? While it’s not always possible to prevent cysts entirely, complete surgical excision offers the best chance of preventing recurrence at the same site. However, new cysts may still form in other areas.

Differentiating Sebaceous Cysts from Other Skin Growths

Sebaceous cysts can sometimes be confused with other types of skin growths. How can you tell the difference? While a definitive diagnosis requires professional evaluation, here are some characteristics that can help distinguish sebaceous cysts from other common skin conditions:

Sebaceous Cysts vs. Lipomas

• Lipomas are soft, fatty lumps that move easily under the skin.
• Unlike sebaceous cysts, lipomas don’t typically have a visible pore or opening.
• Lipomas are often larger and can occur deeper under the skin.

Sebaceous Cysts vs. Pilar Cysts

• Pilar cysts, also known as trichilemmal cysts, are similar to sebaceous cysts but occur almost exclusively on the scalp.
• They tend to be smoother and more mobile than sebaceous cysts.
• Pilar cysts are often hereditary and may run in families.

Sebaceous Cysts vs. Abscesses

• Abscesses are painful, swollen, pus-filled lumps that result from bacterial infection.
• They are typically more painful and inflamed than sebaceous cysts.
• Abscesses often develop more rapidly and may be accompanied by fever or other systemic symptoms.

Why is accurate identification important? Proper diagnosis ensures appropriate treatment. While sebaceous cysts often don’t require immediate intervention, conditions like abscesses may need prompt medical attention.

Psychological Impact of Sebaceous Cysts

While sebaceous cysts are typically benign from a medical standpoint, they can have significant psychological effects on some individuals. How do sebaceous cysts affect mental health and quality of life?

• Body image concerns: Visible cysts, especially on the face or other exposed areas, can affect self-esteem and body image.
• Social anxiety: Some people may feel self-conscious about their cysts in social situations.
• Worry about malignancy: Despite the low risk, some individuals may experience anxiety about the possibility of cancer.
• Discomfort in daily activities: Large or strategically located cysts can interfere with clothing choices or physical activities.

How can these psychological effects be addressed? Open communication with healthcare providers about these concerns is crucial. In some cases, counseling or support groups may be beneficial in addition to medical treatment of the cysts themselves.

Future Directions in Sebaceous Cyst Research and Treatment

As medical science advances, new approaches to managing sebaceous cysts are being explored. What developments can we expect in the future?

• Improved minimally invasive techniques: Research is ongoing to develop less invasive removal methods that minimize scarring and recovery time.
• Biological therapies: Scientists are investigating targeted treatments that could dissolve cysts without surgery.
• Genetic research: Understanding the genetic factors that predispose some individuals to cyst formation could lead to preventive strategies.
• Advanced imaging techniques: New imaging methods may improve diagnosis and treatment planning for complex cases.

How might these advancements change the management of sebaceous cysts? Future treatments could potentially offer quicker, less invasive options with reduced risk of recurrence, improving outcomes and patient satisfaction.

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.

Sebaceous Cyst Symptoms & Treatment

1. Home
3. Services & Specialties
5. Dermatology
7. Sebaceous cyst symptoms & treatment

Dermatology

• Acne and cystic acne causes & treatment
• Actinic keratosis symptoms & treatment
• Dermatitis treatment
• Eczema & dry skin treatment
• Hair loss symptoms & treatment
• Moles – symptoms & treatment
• Nail disease symptoms & treatment
• Nervous sweating
• Psoriasis treatment
• Rashes – symptoms & treatment
• Rosacea symptoms & treatment
• Ringworm symptoms & treatment
• Sebaceous cyst symptoms & treatment
• Warts – symptoms & treatment
• Athlete’s foot

Find a doctor

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.

Get care

We help you live well. And we’re here for you in person and online. 

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.

Causes

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.

Symptoms

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

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.

References

1. 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/
2. Anila Kapadia, Dermatology Registrar, York Teaching Hospital NHS Foundation Trust, United Kingdom, DermNet New Zealand Trust: Trichilemmal cyst // https://dermnetnz.org/topics/trichilemmal-cyst
3. 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
4. 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/
5. Skinsight: Pilar Cyst // Last updated on 11/23/2016 / https://www.skinsight.com/skin-conditions/adult/pilar-cyst

Author:

Amelicheva Alena Aleksandrovna
medical editor

Publication date: 10 December 2021

Update date: 14 February 2023

Atheroma. What is Atheroma?

IMPORTANT
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.

ICD-10

D23 Other benign skin neoplasms

• Causes of atheroma
• Pathogenesis
• Classification
• Atheroma symptoms
• Complications
• Diagnostics
• Atheroma treatment
• Prognosis and prevention
• Prices for treatment

General

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.

Atheroma

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.

Pathogenesis

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.

Classification

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.

Atheroma symptoms

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.

Complications

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.

Diagnosis

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.

Atheroma treatment

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.

References

1. Reference book of a dermatologist / Ivanov O. L., Lvov A. N. – 2012. / Health. Medical ecology. The science. – 2014.
2. Results of surgical treatment of facial atheromas using a sparing method (cystotomy)/ Grigoryeva TS// Medical news.