- 1 WHAT IS A CYST
- 2 Epidermoid Cyst:
- 3 Pilar Cyst:
- 4 Sebaceous Cyst:
- 4.1 What are sebaceous cysts and how are they formed:
- 4.2 Pathophysiology of sebaceous cyst:
- 4.3 Differential Diagnosis:
- 4.4 Lab studies:
- 4.5 Sebaceous Cyst Treatment:
- 4.6 Surgery:
- 4.7 ATYPICAL SEBACEOUS CYST:
- 4.8 HOME REMEDIES:
- 4.9 Suggestions to prevent sebaceous cyst:
- 5 Some frequently asked questions:
WHAT IS A CYST
A cyst is a small, closed sac that may appear on the skin—externally (for example, sebaceous cyst), or different body organs and tissues—internally (for example, ovarian cyst).
Histologically, a cyst is composed of cells different from the surrounding tissues and cells. It has a distinct membrane formed by the cells which come together to form a bubble-like sac. However, the cells making the exterior of that bubble are distinctly abnormal, both in their appearance and characteristics, when differentiated from the typical neighboring cells of that location.
A cyst may be full of air, fluid or semi-fluid. Rarely it can be cancerous, but mostly it is benign and resolve on its own. Sometimes, surgical removal may be needed.
Skin cyst appear in the form of small, fluid filled bump, most commonly on the face, neck, scalp and back, although it can appear anywhere. They do not pose any severe discomfort and are not life threatening. Most of the time people seek help because of cosmetic reasons, especially if they appear on the face or neck.
Depending on the origin of cells, skin cysts have been divided into:
As the name indicates it evolves from the epidermis—cells lining the skin surface.
The cells at the surface of the skin continuously sheds and are replaced by the new ones. If the cells start shedding into the skin, they began to accumulate and appear in the form a small bump called epidermoid cyst.
Also called ‘wen’ or ‘trichilemmal cyst’, these cysts evolve from the cells in hair follicles. Pilar cysts are found in hairy regions like scalp and their sac is filled with keratin (a protein found in nails, skin, hairs). These cysts mostly run in families, are benign and vary greatly in size.
These cysts arise from the sebaceous glands, surrounding the base of normal hairs.
What are sebaceous cysts and how are they formed:
Sebaceous glands, also known as oil-producing glands, are located near the hair follicles. Their function is to produce oily substance called sebum, which travels via sebaceous duct and open in the upper part of the hair follicle. From there sebum reaches the skin surface. Sebum plays a role in skin and hair lubrication. It is a mixture of triglycerides, wax esters and cholesterol. These oil-producing glands are present almost everywhere we have hair follicles except soles and palms. That is why the sebaceous cyst are rare in palms of the hand and soles of the feet.
Pathophysiology of sebaceous cyst:
Sebaceous cyst usually is the result of the damage of the sebaceous gland, or the blockage of follicular duct, or both. As a result, sebum fails to get expelled out and gets plugged inside the skin. As it accumulates, it gets a nodular smooth appearance. Sometimes acne causing bacteria acts on this trapped sebum and breaks down the cholesterol into fatty acids—eventually giving rise to acne.
Some of the causes include:
- Impaired duct, as a result of a trauma or as result of skin conditions like acne.
- Increased production of sebum on the skin.
- Damage during surgery or deep implantation of skin surface cells resulting from a penetrating lesion or laceration.
- Swollen hair follicles.
- Genetic conditions: ‘Steatocystoma multiplex’ is a rare inherited disorder in which multiple sebaceous cysts form in different parts of the body. It usually appears at the time of puberty. Steatocystomas are thought to originate from the atypical lining of the sebaceous duct. It is inherited in an autosomal dominant fashion (which means one of the parent have the condition). However, some cases are also sporadic (which means no family member is affected). Treatment may include minor surgery to remove cysts. In case of infection or inflammation antibiotics or oral isotretinoin is used.
- High levels of testosterone and androgenic anabolic steroids may result in excessive sebum production. This can in turn cause blockage of the sebum-secreting sebaceous glands. This is one of the reason why sebaceous cyst are so common among body builders who take anabolic steroids.
- No apparent reason, but patient may have past history of trauma and have forgotten about it. Since sebaceous cyst grows slowly and may take a long time to become noticeable, longterm history of skin trauma is significant.
The main presentation of sebaceous cyst is a small, smooth and round lump under the skin. Unless infected, it is painless. It is found usually on the face, neck, behind the ears or torso.
Sebaceous cysts are slow growing and can remain small for years. In some cases, they stop growing and disappear on their own. However, in some, they continue to grow and can gain considerable size.
Sometimes cysts present with a tiny blackhead that is clogging the orifice of the cyst. They may discharge a grayish substance which may dry up to form a horn in the center.
Why do I have a lump behind my ear?
A sebaceous cyst can become inflamed and appear swollen and tender to touch. Inflammation doesn’t necessarily mean an infection, it is just a body’s response to expel the cells that don’t belong there. In addition, most of the doctors would want to wait till inflammation subsides considerably before operating on it. Some doctors prefer using steroid injection to help lessen the inflammation.
Cysts can become red, hot and painful when infected. They can grow large to harbor abscess and may call for the antibiotic full course. Be sure to finish the course of antibiotic as it is necessary to fight the infection. In as little as one week, the infection begins to subside.
It is advisable to call the doctor if any of the following symptoms appear.
- Expanding area of redness around the cyst.
- Swelling and pain getting aggravated.
- High fever (100.4°F or higher).
- Pus discharge from the cyst.
Ruptured cyst often leads to infection. When cysts are ruptured chronically, they turn into a mix of scar tissue and become difficult to treat. It is generally best to remove the entire area surgically.
- Skin cancer:
In extremely rare cases, cysts can be found linked to skin cancer.
Common differentials include lipoma, abscess and swollen lymph nodes. Multiple cysts in a young patient indicates Gardner’s syndrome.
Difference between lipoma and sebaceous cyst:
Lipoma is a benign tumor formed by the overgrowth of fat cells under the skin and this overgrowth result in a round smooth mass. Lipomas are usually small but with time they can grow really big. Very rarely they turn malignant. They are painless and when pressed upon you can feel them move under your finger. On the other hand, sebaceous cyst do not grow as fast as lipomas and have well defined shape. Also, they do not move when pressed upon like lipomas, who tend to go deeper into the skin. Also, sebaceous cyst may have redness and swelling in the surrounding skin, both things not seen in lipomas.
Difference between boil (abscess) and sebaceous cyst:
Abscesses is by definition a localized bacterial infection and have tendency to produce pus. Abscess may present with fever, pain and other signs of localized infection. They often require antibiotics and drainage as treatment. Sebaceous cyst may become infected and turn into abscess.
Difference between lumps nodes and sebaceous cyst:
Lymph nodes are present throughout our body and is a part of the lymphatic system. lymph nodes filter a fluid called lymph from the harmful substances and different pathogens. When fighting infection as a part of immune response they become swollen and can be confused with sebaceous cysts. They are found in neck, armpits, groin, abdomen and chest. Medical doctors know where these are located and help in distinguishing them from cyst. Sometimes, imaging techniques are also required to make the right diagnosis.
Difference between Gardener’s syndrome and sebaceous cyst:
Gardner’s syndrome is a autosomal dominant disease which is characterized with multiple skin cysts (epidermoid cysts), desmoid tumors and other skin tumors. Along with that it has other distinguished features, like multiple osteomas and gastrointestinal polyps.
The diagnosis is mainly clinical and made by general examination by your doctor. However, lab studies may be required to rule out other differentials.
Sebaceous Cyst Treatment:
Normally, no treatment is required for these lesions.
People may want to remove it for cosmetic reasons. Sometimes, it may grow so large that it starts to interfere with the normal functioning of the area. In such cases surgical removal is recommended.
Before you go to the doctor it is a good practice to keep a log of few things—first time you noticed the cyst, are there more than one, if there is a family history of cysts and history of any recent or old skin injury.
Three main techniques used for the removal of sebaceous cysts are, traditional wide excision, punch biopsy excision and minimal excision.
Traditional wide excision
During this procedure the cyst is removed completely from the surrounding tissue. The techniques is time consuming and leads to significant scarring, but it has almost no recurrence rate when the cyst is completely removed.
Minimal excision and Punch biopsy
During these procedures, the cyst is removed with minimal bleeding and produce less scarring. The procedure time is short and the healing times are better. But, they have high recurrence rate.
According to Gabrielle O’Sullivan, MD University of Washington, Seattle, for large cysts that are intact and doesn’t show signs of inflammation or infection, the best techniques would be the one that requires minimal intervention and produce best results cosmetically, especially when the face is involved. For this, minimal excision technique is preferred as it leaves very little scarring and also has faster healing times and speedy recovery. But, if the cyst has recurred after minimal excision, or ruptured, it is best to do the traditional wide excision.
A new technique using laser:
According to an article in the U.S national library of medicine, national institute of health, a new method to treat sebaceous cyst has been proposed, which is better than the surgical excisions alone.
This new method uses both the laser technique and surgical excision in an un infected sebaceous cyst. First, laser is used to make a small hole to remove the contents of the cysts. One month later, the wall of cyst become small and through minimal excision surgery the cyst wall is completely removed. It is said to be more beneficial for very large cysts, causing a very little scarring and providing satisfactory cosmetic results.
ATYPICAL SEBACEOUS CYST:
There are some atypical cases with sebaceous cyst in very unusual places. These unusual places may pose a problem in diagnosis and management and require careful examination. For example, multiple sebaceous cysts on the scrotum, sebaceous horn over the elbow and over the first web space. In women, sebaceous cyst on vulva is a typical benign valvular cyst that may cause discomfort during urination, using tampon or during sex. Just like scrotum they can be solitary or multiple. However, in both cases proper pelvic exam is required, followed by testing for sexually transmitted diseases (if necessary). After excision mass can be send for biopsy. Sometimes the sebaceous cyst on vulva is fluctuant due to accumulation of fluid and fine needle aspiration can be performed. Just like others, these cysts can undergo infection, severe pain and abscess formation and requires a proper hygiene for prevention.
Resist any temptation to squeeze the cyst or pop it like a pimple. It doesn’t help in healing the cyst, instead, it can further irritate the area and cause inflammation. If the cyst bursts under the skin, it could expose the bacteria to the surrounding tissue and spread the infection.
It is understandable that you may want to try some DIY remedies before seeking the medical advice. Luckily, there are few home remedies that may prove to be beneficial if used with caution.
This is one of the most useful home remedy that may help heal sebaceous cyst faster. Heat, when applied to the skin promotes blood circulation and cause vaso-dilation, which means there is an increased chance of washing out the toxins through dilated vessels. Just take a warm towel and apply it on the site for ten to twenty minutes. Doing this two to three times a day would help. Additionally, the warm sensation act as a counter irritant that masks the discomfort and reduce pain caused by the inflammation.
Tea tree oil:
Tea tree oil is known to have anti-bacterial and anti-inflammatory properties. Application of one to two drops of tea tree oil on the infected sebaceous cyst, can help reduce inflammation and can also reduce the recurrence of cysts.
Castor oil is known to contain a chemical called ricin. Ricin has anti-bacterial properties and helps to reduce itching and inflammation. Soak a clean piece of cloth or cotton pad in castor oil and apply it to the cyst, cover it with the hot compress and hold it for some time. Repeat the process two to three times a day. In place of hot compresses, you can also use heat pads or hot water bottles.
Aloe vera is particularly famous for its nurturing effects on the skin. It carries a lot of healing properties in its fleshy leaves that help in inflammation and also reduce scarring. With anti-bacterial properties, it can relieve pain and skin discomfort. Directly apply it on the cyst once or twice a day with some gentle rubbing so it gets absorbed into the skin. It is also recommended for faster healing.
Apple Cider Vinegar:
Soak a cotton ball in some apple cider vinegar and apply to your cyst. You may experience some stinging sensation, that is because of its strong anti-bacterial, anti-fungal and anti-septic properties. It is a strong natural astringent and helps ease the discomfort caused by the cyst.
Suggestions to prevent sebaceous cyst:
Sebaceous cysts is caused by increased production of sebum. Taking measures to control excess sebum production and bacterial growth (like in acne), can tremendously help preventing sebaceous cysts. Needless to say, it is important to keep the face clean by proper washing at-least two to three times a day. Greasy makeup and cosmetics that can clog skin pores can also take part in aggravating the skin conditions like sebaceous cysts, acne etc. It is of significance to make sure the makeup is according to your skin type and doesn’t clog your pores. Avoiding the excessive heat and sun exposure might help too.
In addition, a diet that encourage excessive production of sebum may also contribute to the situation and better be avoided.
For healthier skin, drink lots of water and eat fresh fruits and vegetables to clear away toxins from the body and build up the immune system.
Take a nutritious diet which is rich in antioxidants like Zinc, Vitamin C, Vitamin B, Vitamin E and Selenium.
Keep the surrounding area clean and wash with anti-bacterial soap.
Do not irritate the cyst by scratching or squeezing and let it drain naturally.
When cyst becomes inflamed, swollen and painful—seek medical advice.
Stay away from greasy diet rich in saturated fats and trans fats.
Some frequently asked questions:
How long does sebaceous cysts last without treatment?
Most of the cysts disappear on their own and doesn’t require medical intervention. They grow slowly, so it is advisable to keep an eye on them and if signs of inflammation or infection appears—seek medical advice.
Can I remove sebaceous cyst by myself?
Removal of sebaceous cyst should not be attempted at home. It is best done by medical professional, who can determine the best mode of treatment after careful examination. If you try to pop the cyst, keep in mind two things.
- You are exposing it to pathogens and welcoming infections.
- Cyst will recur, as popping or squeezing doesn’t remove it completely and slightest of the capsule portion left behind will cause it to regrow.
Can a sebaceous cyst be removed with TCA acid?
No, it cannot. Trichloroacetic acid (TCA) peels are commonly used to reduce pigmentation and scarring left by acne. It may help with cyst scarring after it has completely healed and should be used only after consultation with dermatologist. However, the use of TCA is not for cyst removal.
Does sebaceous cyst removal leave a scar?
It depends on the size of the cyst, and type of the technique used to remove it. Some people have skin prone to get scarring. It also depends on your general health e.g diabetes and vascular diseases may impair prompt healing.
Can benign cyst turn cancerous?
Sebaceous cysts and any cyst for that matter, are rarely cancerous. They are mostly benign but it is immensely important, when in doubt, to find out whether what you have is a cyst or something else. This is done by ultrasound or other techniques at your doctor’s office.
Can you die from sebaceous cyst?
Mostly not, but rarely, yes. If your cyst gets infected and left untreated, it may lead to sepsis.