Sebaceous Cysts: Symptoms, Causes, Diagnosis, and Treatment

In the field of dermatology, sebaceous cysts remain a topic of persistent intrigue and clinical significance. While generally benign in nature, sebaceous cysts can pose both cosmetic and medical concerns. Understanding their origins, characteristics, and appropriate management is crucial for both healthcare professionals and individuals encountering these cysts. In this article, we’ll learn more about sebaceous cysts, delving into its clinical aspects, potential causes, diagnostic procedures, and treatment options, providing a comprehensive overview of this common yet often misunderstood dermatological condition. Read on.

What is a Sebaceous Cyst?

A sebaceous cyst, also known as an epidermoid cyst, is a closed sac or lump beneath the skin that forms as a result of the sebaceous glands' blockage. These glands are responsible for producing sebum, an oily substance that lubricates the hair and skin. When a sebaceous gland becomes blocked, sebum can accumulate, leading to the formation of a cyst. Sebaceous cysts typically appear as small, round or oval lumps that are often firm or mobile under the skin. They are usually slow-growing and can develop anywhere on the body, though they are commonly found on the face, neck, back, or torso. Sebaceous cysts are typically non-cancerous and do not usually cause pain, although they may become tender or infected over time. While they are generally harmless, some people opt for removal due to cosmetic concerns or recurring issues.

Symptoms of Sebaceous Cyst

Sebaceous cysts often present with distinctive symptoms, although these may vary in intensity and can be influenced by factors such as infection or inflammation. Common symptoms of sebaceous cysts include:

• Painless, Firm Lumps: Sebaceous cysts are typically painless and can be felt as small, round or oval lumps beneath the skin. They are often firm to the touch and may have a smooth or slightly raised appearance.
• Skin Discoloration: In some cases, the overlying skin may appear slightly discolored, such as red or pink. This discoloration can be more prominent if the cyst is inflamed or infected.
• Fluctuation in Size: Sebaceous cysts can vary in size over time. They may remain stable for a while and then suddenly increase or decrease in size, particularly if they become infected or if there is an accumulation of sebum within the cyst.
• Mobility: Sebaceous cysts are typically mobile beneath the skin, which means they can be moved slightly when touched.
• Infection: If a sebaceous cyst becomes infected, it can lead to symptoms such as redness, tenderness, warmth, and swelling in the affected area. It may also produce pus or a foul-smelling discharge. Infected cysts can be painful.
• Discomfort: While sebaceous cysts are usually not painful, they can occasionally cause discomfort if they press against nerves or surrounding structures.

Sebaceous cysts are generally benign and their symptoms are usually mild, but they can become more problematic if they become infected, inflamed, or if they rupture. In such cases, medical

attention may be necessary. Additionally, if you notice any changes in the appearance, size, or symptoms of a sebaceous cyst, it is advisable to consult a dermatologist for evaluation and appropriate management.

Causes of Sebaceous Cysts

Though the exact cause of sebaceous cysts can vary from person to person, the primary factors contributing to their development include:

• Sebaceous Gland Blockage: The sebaceous glands in the skin produce an oily substance called sebum, which helps lubricate the skin and hair. When a hair follicle or duct of a sebaceous gland becomes blocked, it can trap sebum beneath the skin's surface. This blockage is a key factor in the formation of sebaceous cysts.
• Trauma or Injury: Physical trauma or injury to the skin can disrupt the normal function of sebaceous glands and hair follicles, potentially leading to the development of a cyst.
• Hormonal Changes: Hormonal fluctuations can impact the sebaceous glands, making them more prone to blockage. This is why sebaceous cysts are more common during puberty and can also occur during pregnancy.
• Genetic Predisposition: Some individuals may have a genetic predisposition to developing sebaceous cysts. If a family member has a history of sebaceous cysts, there may be a higher risk of developing them as well.
• Excessive Sebum Production: An overproduction of sebum can contribute to the formation of sebaceous cysts. Conditions such as seborrheic dermatitis, which increases sebum production, may be a contributing factor.
• Inflammatory Skin Conditions: Inflammation in the skin, such as that seen in acne or other skin conditions, can lead to the formation of sebaceous cysts.

Note: Sebaceous cysts are generally not associated with poor hygiene, and are not contagious. Furthermore, while they can occur in individuals of all ages, they are most common in young and middle-aged adults.

Diagnosis of Sebaceous Cysts

The diagnosis of sebaceous cysts is typically straightforward and can often be made based on a physical examination by a dermatologist. The diagnostic process typically includes the following:

• Medical History: The doctor will begin by taking a detailed medical history. They may inquire about the patient's symptoms, the duration of the cyst, any changes in size or appearance, and any previous occurrences of similar cysts.
• Physical Examination: The doctor will conduct a physical examination, during which they will inspect the cyst, noting its size, shape, colour, and texture. They will also assess the surrounding skin for inflammation, infection, or tenderness.
• Clinical Assessment: The physical examination helps the healthcare provider assess the cyst's characteristics and distinguish it from other skin conditions, such as lipomas or abscesses.
• Palpation: The doctor may gently touch and palpate the cyst to evaluate its mobility and determine if it feels firm, soft, or fluctuant (containing fluid). This can help confirm the diagnosis.
• Observation: In most cases, the diagnosis of a sebaceous cyst can be made based on the examination. The cyst typically presents as a non-painful, movable lump beneath the skin, often with a central pore or punctum. It may exude a thick, white, cheesy material when squeezed.
• Imaging (Rarely): In some cases, medical imaging, such as ultrasound, may be used to assess the size, location, or characteristics of the cyst, especially if it is deep-seated or if there is uncertainty about the diagnosis.

While sebaceous cysts are usually easily diagnosed through physical examination, it's advisable to consult a dermatologist and get a proper assessment. If there are concerns about the diagnosis or if the cyst requires treatment or removal, the doctor will discuss appropriate management options.

Sebaceous Cyst Treatment Options

The treatment of sebaceous cysts depends on various factors, including the size of the cyst, its location, whether it's causing symptoms, and whether it's infected. Here are the primary treatment options for sebaceous cysts:

• Incision and Drainage: If a sebaceous cyst becomes painful or inflamed, it may need to be drained. The procedure involves making a small incision in the cyst, allowing the contents (sebum and debris) to be expressed. This can provide relief from discomfort and may be followed by a course of antibiotics if infection is present.
• Intralesional Steroid Injection: For cysts that are repeatedly inflamed or painful, healthcare providers may use intralesional steroid injections. This involves injecting a corticosteroid directly into the cyst to reduce inflammation and symptoms.
• Laser Therapy: Laser therapy can be used to remove the contents of the cyst and promote healing. This may be a suitable option for cysts on the face or other visible areas to minimize scarring.
• Surgical Excision: Larger cysts, those causing cosmetic concerns, or those that have recurred may be removed surgically. The procedure typically involves making an incision, excising the entire cyst along with the cyst wall, and closing the incision with sutures. This is usually done under local anesthesia.
• Minimal Invasive Techniques: Some healthcare providers may use minimal invasive techniques, such as minimal excision, to remove sebaceous cysts with smaller incisions, reducing scarring and recovery time.
• Antibiotics: If a sebaceous cyst is infected, antibiotic treatment may be prescribed to address the infection. Once the infection is under control, the cyst can be treated as necessary.
• Observation: Small, asymptomatic sebaceous cysts that are not causing any issues may not require treatment. In such cases, the healthcare provider may recommend a "watch and wait" approach, periodically assessing the cyst for changes.

The choice of sebaceous cyst treatment depends on the individual case and should be discussed with a dermatologist or a surgeon. The decision will take into account the size, location, and characteristics of the cyst, as well as the patient's preferences and any associated symptoms. In addition, it is important to remember that attempting to squeeze or rupture a sebaceous cyst at home is not recommended, as this can lead to infection, inflammation, and potential scarring. Moreover, incomplete removal can result in cyst recurrence.

Recovery After Sebaceous Cyst Removal

Though the recovery process following the removal of a sebaceous cyst typically depends on various factors, such as the size of the cyst and the method of removal, here's a general overview of what to expect during the recovery period:

• Incision Care: If the sebaceous cyst was removed via surgical excision, it's essential to keep the incision site clean and dry to prevent infection. You may need to apply an antibiotic ointment and cover the wound with a sterile dressing as directed by your healthcare provider.
• Stitches Removal: If sutures were used to close the incision, your healthcare provider will specify when to return for suture removal. This usually occurs within a week to ten days after the procedure.
• Pain and Discomfort: Some post-operative pain and discomfort are common. Over-the-counter pain relievers may be recommended by your healthcare provider to manage pain. Any prescribed pain medication should be taken as directed.
• Swelling and Bruising: Mild swelling and bruising around the surgical site are normal and should subside within a week or two.
• Activity Restrictions: Your healthcare provider may advise you to limit physical activity or avoid strenuous exercise for a certain period to allow for proper healing.
• Wound Care: Carefully follow your healthcare provider's instructions for wound care. This may involve gentle cleaning of the incision site, changing dressings, and applying antibiotic ointment.
• Scar Management: To minimize scarring, you can discuss with your healthcare provider the use of scar-reducing treatments or ointments after the incision has fully healed.
• Return to Normal Activities: Most individuals can return to their regular activities within a few days to a week after sebaceous cyst removal, depending on the location and extent of the procedure.
• Follow-Up Appointments: Be sure to attend all scheduled follow-up appointments with your healthcare provider. This allows them to monitor the healing process, check for any signs of infection, and remove sutures if necessary.
• Complications: While complications are relatively rare, it's essential to monitor the surgical site for any signs of infection (redness, increased pain, discharge), excessive swelling, or changes in the appearance of the wound.

Generally, the majority of individuals experience a straightforward recovery after sebaceous cyst removal, and any scarring that does occur is typically minimal. However, if you notice any concerning changes, contact your Sebaceous cyst excision doctor promptly.

Frequently Asked Questions about Sebaceous Cysts

Q: Can sebaceous cysts go away on their own?

Sebaceous cysts may persist and even fluctuate in size over time, but they do not typically go away on their own. Treatment may be necessary to address symptomatic or problematic cysts.

Q: Are sebaceous cysts painful?

Sebaceous cysts are generally painless, especially when they are not infected. However, if a cyst becomes inflamed, infected, or presses on nerves or surrounding structures, it can cause pain or discomfort.

Q: Should I pop a sebaceous cyst at home?

No, it is not advisable to attempt to pop or rupture a sebaceous cyst at home. This can lead to infection, inflammation, and potential complications. It's best to consult a dermatologist or surgeon.

Q: Do sebaceous cysts always return after removal?

Sebaceous cysts may recur if the entire cyst and its lining are not removed during surgical excision. Properly executed removal procedures aim to minimize the risk of recurrence.

Q: Can sebaceous cysts turn into skin cancer?

Sebaceous cysts are benign and do not turn into skin cancer. However, if you notice any changes in a cyst's appearance or if it becomes symptomatic, have it evaluated by a specialist.

Q: What's the difference between a sebaceous cyst and a boil?

Although sebaceous cysts and boils may appear similar, they have distinct differences. While sebaceous cysts develop from blocked sebaceous glands and are generally painless, boils are painful, red, and inflamed lumps caused by a bacterial infection in a hair follicle or oil gland.

Q: What are the tests done for sebaceous cysts?

The diagnosis of sebaceous cysts is typically made through a physical examination by a doctor. No specific laboratory tests are commonly required. In some cases, however, medical imaging, such as ultrasound, may be used to assess the cyst's characteristics or location.

Q: When is surgery needed for sebaceous cysts?

Surgery for sebaceous cysts is typically considered when the cyst is symptomatic, infected, recurrent, or causing cosmetic concerns. Surgical removal is also recommended if the cyst is large, painful, or located in an area that may impede normal functioning.