Cysts

Cysts on the skin are harmless flesh-colored bumps under the skin, usually located on the face, neck and trunk. Cysts are commonly called epidermal cysts, epidermoid cysts, epidermal inclusion cysts, or improperly as “sebaceous cysts”. These cysts form when the top layer of skin that normally sheds every few weeks, moves deeper into your skin and clogs a pore. With time, the layer becomes a living lining that secretes the protein keratin and dead skin cells accumulate further clogging the pore. Sometimes cysts form when skin or a hair follicle is injured. Sometimes cysts are visible as tiny blackheads plugging the opening of the cyst, and at other times a thick, foul-smelling substance can drain from the cysts. Cysts can occur in unusual numbers and locations such as shoulders and arms in rare inherited conditions like Gardner Syndrome.

Epidermal cysts have three fates: they remain stable, they enlarge with time, or they resolve with spontaneous rupture and drainage if the lining (sac) of the cyst scars down. Cysts are usually slow-growing and often painless, thus rarely needing treatment. However, larger cysts may be unsightly, painful, ruptured, infected, and can occasionally cause physical disfigurement. Sometimes cysts get infected when patients manipulate or lance the cysts at home using non sterile techniques or instruments. A foul-smelling pus draining from the cyst or severe redness and swelling around the cyst is usually a sign of infection and needs immediate attention.

Treatment options include surgery in which the entire cyst, including the lining, is surgically removed. The edges of skin are then sutured to close the gap left by the cyst. This is done in an office setting under local anesthesia. Cysts can also be drained especially if fluctuant from infection and pus collection. Bacterial cultures to confirm the identity of infection-causing bacteria and a course of appropriate oral antibiotics might be needed. Unless the sac or lining of the cyst is entirely removed, the cysts may grow back. It is important to submit any collected cyst specimen and lining for pathological evaluation by a trained dermatopathologist to rule out worrisome mimickers of cysts like desmoplastic melanoma, cystic basal cell cancer, or trichoblastic carcinoma.

Talk to our dermatologists if you develop any worrisome signs or symptoms so the best treatment option can be presented to you.