The two most common skin cysts are epidermoid cysts and sebaceous cysts. Typically harmless, cysts are bumps that show up under the skin. In this article, we will go through what exactly are epidermoid and sebaceous cysts, what are the causes, and treatment options for cyst removal by a dermatologist.
What are epidermoid cysts?
A cyst is a benign (non cancerous), round, dome-shaped bump that contains fluid or other material. They can appear anywhere on the skin, but are most common on the face, neck, and trunk (e.g chest and shoulders). They are also common on the scrotum and vulva.
Unlike epidermoid cysts which originate from the skin, true sebaceous cysts are rare and originate form the sebaceous glands.
Sebaceous cysts can be found over you entire body, except for the palms of your hands and the soles of your feet. When squeezed, a small dome shaped projection called a punctum will appear. Through that opening, the sebum may be squeezed out.
Signs of an epidermoid cysts include:
A small blackhead on the opening of the cyst
A thick, smelly yellow material that may drain from the cyst
Sebaceous cysts (commonly mistakenly identified as these cysts do not involve sebaceous glands)
What causes an epidermoid cyst?
The epidermis – top layer of your skin – is made up of a thin, protective layer of cells that your body sheds continuously. Most epidermoid cysts form when these cells move into the deeper layers of your skin and multiply rather than shed. This causes a buildup of keratin in the skin, developing into cysts.
Sometimes, the epidermoid cysts can form due to irritation or trauma to the skin, or a portion of the hair follicle. The epidermal cells are the walls of the cysts which secrete the protein keratin into the interior. The keratin is the thick, yellowish substance that sometimes drains from the cyst.
What causes a sebaceous cyst?
Sebaceous cysts come from your sebaceous glands. Cysts can develop if the gland gets damaged, or the passage through which sebum leaves the skin is blocked. This usually occurs because of some sort of trauma in the area such as a scratch, surgical wound, or skin condition like acne.
Who gets epidermoid cysts?
Epidermoid cysts occur most commonly in adults, especially when young to middle aged. Additionally, they also occur twice as more frequently in men. Injuring the skin can also lead to development of epidermoid cysts.
Having certain rare genetic disorders may also increase the risk of developing epidermoid cysts:
Basal cell naevus syndrome
Pachyonychia congenita type 2
Epidermoid cysts vs sebaceous cysts
Many refer to epidermoid cysts as sebaceous cysts, but they are different. True sebaceous cysts are much less common. Sebaceous cysts start in the sebaceous gland. This is an oil gland in the skin that secretes oil, or sebum that lubricates the skin and hair.
What are the options for cyst removal?
Most epidermal cysts are slow growing and painless, so they don’t usually need treatment. However, if the cyst grows rapidly, ruptures or becomes painful, bothers you for cosmetic reasons, or occurs in a spot that causes irritation, you can see a skin specialist to have perform an epidermoid cyst removal.
Talk to your dermatologist about these options:
Injection: this involves injecting the cyst with a steroid that reduces inflammation and swelling.
Incision and drainage: Your dermatologist will make a small cut in the cyst, and gently squeeze out the contents. While this method is fairly quick and easy, cysts tend to recur after this treatment.
Complete surgical excision: The most effective treatment for is a a complete epidermal cyst removal. Your doctor will remove the entire cyst with an intact cyst capsule. This is done through minor surgery in which you need to return to have stitches removed.
Looking for cyst removal procedures in Singapore? Book a TeleConsultation with MOH accredited dermatologist, Dr. Teo Wan Lin, to have your condition addressed. Click on bottom left button to contact us or simply click here to book an appointment now.
While acne is a common skin disease, it is often difficult to treat severe acne, like the nodulocystic form. Also known as cystic acne or nodular acne, such severe forms can cause significant damage to the skin and affect one’s self-esteem.
Is my acne mild or severe?
If you find that you have only one or two pimples appearing at a certain time of the month, it is considered physiological acne and it is mild. The occasional outbreak you experience is often resolved on its own.
However, if the original blackhead or whitehead becomes badly infected by surface bacteria that it triggers the skin’s inflammatory response, a cyst wall may form around the original site of inflammation.
How do I know if I have cystic acne?
Cystic acne, or nodular acne, are larger and more severe than the typical pimple. These nodules feel like stubborn, firm bumps under the skin and can last for months. You can get them on the face, neck, back, chests or shoulders.
What causes cystic acne?
Cystic acne develops from milder forms of acne. Oil and dead skin skins that clog the oil gland also traps bacteria within, causing inflammation. You may also be genetically disposed to developing cystic acne, if your parents had severe nodules, you are more likely to get it.
Hormones are also another major cause for cystic acne, which may explain why they can develop during puberty. Hormonal changes that take place during pregnancy can also trigger cystic acne.
What happens when your cystic acne is not treated?
Treatment of cystic acne can be challenging as topical treatment is usually less effective. If left untreated, your cystic acne may become a permanent scar. This can be painful, red and get secondarily infected over time. If the condition worsens, an abscess will develop, that is a collection of pus under the skin.
Do not squeeze or pick the pimple, as it introduces more bacteria to an already infected cyst. Extraction of the cyst with sharp objects by non-medical professionals should also be avoided, as they are not safe and sterilized in a medical environment. Doing so only introduces potential for bacteria to affect you, even if you are not acne prone.
For example, we have been referred patients who had what started as an ordinary pimple, infected by a rare infection known as atypical mycobacteria. The bacteria originated from tap water with use of an unsterilized instrument by a facialist, leading to granulomatous infection of the skin and led to a sequence of biopsies as well as several months of oral antibiotics for treatment.
How should you treat cystic acne?
When you develop a single bump that becomes large and painful, it is a sign that your acne may be severe. If the acne does not disappear after a maximum of 2 months, it is unlikely that it is just normal physiological acne. This warrants medical treatment before the cystic acne worsens. Over-the-counter acne treatments are less effective against cystic acne and it is best to visit an accredited dermatologist as soon as possible.
Under the care of a dermatologist for assessment, one would expect an injection of triamcinolone, a steroid that can reduce swelling and inflammation, leading to the resolution of the cyst wall.
Another common therapy is oral isotretinoin, known for its efficacy for cystic acne. Severe acne tends to be unresponsive to drugs such as oral tetracycline or topical adapalene/benzoyl peroxide. It helps to fight acne by reducing the size and activity of your oil glands and reducing acne-causing bacteria. However, isotretinoin also has side effects, limiting its usefulness for certain patients. Side effects include liver damage, depression, behavioural change and risk of causing serious birth defects. Isotretinoin can also make your skin feel very dry. Your eyes will also feel drier than normal.
Cosmeceuticals should also be used in tandem with oral medications. Use moisturizers regularly, such as Multi-CERAM™ Moisturizerfor a healthy and hydrated skin barrier. Vitamin Cserums have anti-acne abilities and help to accelerate healing scars. An anti-bacterial cleanser is also essential to allow a thorough cleanse, consider a gentle cleanser such as Miel Honey™ Cleanser.