Sebaceous cyst

sebaceous cyst, also known as an epidermoid cyst or keratin cyst, is a benign growth that typically forms beneath the skin. These cysts originate in the sebaceous glands, which secrete a waxy substance known as sebum that lubricates hair and skin.

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Etiology and Location

Sebaceous cysts often occur due to the obstruction of these glands or damage to a hair follicle, leading to the accumulation of sebum. These cysts can appear anywhere on the skin but are most commonly found on the scalp, face, ears, back, and genital area.

Appearance and Symptoms

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Sebaceous Cyst

A sebaceous cyst usually presents as a round, non-tender, slow-growing lump beneath the skin. The size can vary from a few millimeters to several centimeters in diameter. A central pore or punctum may be visible, representing the blocked hair follicle. These cysts are typically filled with a thick, cheese-like substance composed of keratin, a protein found in skin, hair, and nails.

Although sebaceous cysts are generally asymptomatic, they can become painful if infected or inflamed. In such cases, they may become red, warm to touch, and cause discomfort.

Treatment

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Inflamed epidermal inclusion cyst

The treatment of a sebaceous cyst depends on its size, location, and whether it's causing symptoms. If the cyst is small and not bothering the patient, it can be left alone. However, if the cyst is large, painful, or in a bothersome location, it may need to be removed.

Removal is usually done via a minor surgical procedure where the cyst and its contents are excised. If the cyst is infected, it may first be treated with antibiotics and then removed once the infection has cleared. In some cases, a healthcare provider may perform an incision and drainage procedure to remove the cyst contents, but this approach may have a higher risk of cyst recurrence because the cyst wall remains intact.

Prevention

While it is difficult to prevent sebaceous cysts, maintaining good skin hygiene may help reduce the risk of skin infections and blockages that can contribute to cyst formation.

Potential Complications

While most sebaceous cysts are benign and do not cause serious issues, complications can arise. For example, cysts can become infected, leading to abscess formation, which may require additional treatment. Also, larger cysts may become uncomfortable and interfere with daily activities, particularly when located in areas of frequent friction. In rare cases, a cyst may rupture, causing local inflammation and a potential skin infection.

Additionally, if the cyst is repeatedly irritated or injured (such as by frequent picking or squeezing), it may increase the risk of the cyst becoming permanently inflamed or scarred. Therefore, it's recommended to avoid disturbing a sebaceous cyst and seek medical advice for suitable management.

Differential Diagnosis

It's important to distinguish sebaceous cysts from other types of skin growths or lumps. These may include lipomas (benign fatty tissue growths), dermatofibromas (firm, non-cancerous skin growths), or malignant lesions such as skin cancers. If there is uncertainty about the nature of a skin lump, a healthcare professional may recommend a biopsy or removal for examination under a microscope.

Prognosis

The prognosis for sebaceous cysts is generally excellent. Although they can recur after being removed, especially if the entire cyst wall was not excised, they don't pose significant health risks unless they become infected.

Patient Education

Patients should be advised that while sebaceous cysts are typically harmless, changes in a cyst such as rapid growth, pain, redness, or discharge should prompt medical evaluation. It's also important to educate patients about the risk of self-manipulation, including attempts to squeeze or puncture the cyst, as these actions can lead to infection or scarring.

Summary

While sebaceous cysts are common and generally benign skin conditions, they can cause discomfort and cosmetic concerns. Effective treatment options are available and involve minor surgical interventions. Regular skin hygiene and avoidance of self-manipulation are important in managing these cysts.

References

• [1] Fuggle NR, Brindle R, James T, et al. (2020). Recognition and management of common dermatological conditions in primary care. The British Journal of General Practice, 70(696), 346-353.
• [2] Zuber TJ. (2002). Minimal Excision Technique for Epidermoid (Sebaceous) Cysts. American Family Physician, 65(7), 1409-1412, 1417-1418, 1420.
• [3] Goldberg LH, Alam M. (2008). Physician performance and outcomes in office-based surgery. Dermatologic Clinics, 26(1), 13-21, v.
• [4] Dessinioti C, Katsambas AD. (2017). Sebaceous gland hyperplasia and disorders. Clinics in Dermatology, 35(2), 183-191.
• [5] Wortsman X. (2019). Common Applications of Dermatologic Sonography. Journal of Ultrasound in Medicine, 31(1), 97-111.
• [6] Sterling JC, Gibbs S, Haque Hussain SS, Mohd Mustapa MF, Handfield-Jones SE. (2020). British Association of Dermatologists' guidelines for the management of cutaneous warts 2014. The British Journal of Dermatology, 172(2), 696-709.

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