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Pimple Blackheads: Unmasking the Culprits of Skin Woes
Introduction

Pimple blackheads—those tiny, stubborn dots that seem to defy all skincare efforts—are a common annoyance for many. Whether they camp out on our noses, chins, or backs, blackheads can be perplexing. Let’s delve into their origins, appearance, and strategies for dealing with these pesky skin intruders.

What is a Cyst?

A cyst is a benign, encapsulated lesion that consists of a fluid sac which contains liquid, or semi-fluid material. It can vary in shape, size and location. The most common types of cysts are reviewed here.

Acne, acne cysts, and sebaceous cysts are benign skin lesions and are one of the most common reasons which patients consult with dermatologists like Dr. Michele Green in Manhattan.  Sebaceous cysts are the most common type of cyst, and are slow-growing noncancerous bumps on the skin. However, if sebaceous cysts are left untreated, they tend to enlarge, get infected, and cause cosmetic scarring. Dr. Michele Green treats these sebaceous cysts in her Upper East Side NYC office each day. Through her minimally invasive techniques, she treats these cysts in a cosmetically elegant way, and avoids any unnecessary scarring.

What is a Sebaceous Cyst?

A Sebaceous cyst is like a large pimple. Similar to acne, sebaceous cysts form within or near hair follicles. Sebaceous cysts are benign, firm or palpable growths, which can present as a small lump under the dermis. These cysts are formed from dirt, or excess oil, or a build-up of dead skin and sebum which gets trapped due to clogged hair follicles. Sebaceous cysts can grow rapidly, enlarging over the course of days or weeks.

These cysts most commonly present on the face, back and chest, where the majority of sebaceous glands exist. They do not occur on the palms of the hand or soles of the feet. Sebaceous cysts form a lump under the skin and initially looks like a small bump. The overlying skin is usually flesh colored or yellow in appearance due to the build up of sebum, pus, and keratin. These cysts grow slowly and can also be formed from trauma. Sebaceous cysts may initially be painless, although as large cysts develop, they often become painful. Most sebaceous cyst are not life-threatening, and they can often resolve on their own. However, some sebaceous cysts  do not resolve and need further treatment. Depending on the location of the cyst, the amount of discomfort, the possibility of infection and scarring, and the cosmetic ramifications, these cysts will need to be treated and removed by Dr. Green in her NYC office.

1. Blockage of Sebaceous Glands or Hair Follicles

Sebaceous cysts most commonly form when the opening of a sebaceous gland or hair follicle becomes blocked. The sebaceous glands are responsible for producing sebum, an oily substance that helps to lubricate the skin and hair. When the duct of the sebaceous gland or hair follicle gets blocked, the sebum accumulates inside, leading to the formation of a cyst. This type of cyst is often called an epidermoid cyst or epidermal inclusion cyst.

Mechanism:

• Sebum produced by the sebaceous glands typically exits through hair follicles and helps lubricate the skin. If the follicle is blocked by dead skin cells, sebum, or other debris, the accumulation of these substances results in cyst formation.
• The cyst can gradually increase in size as more material builds up, creating a sac-like structure.

Reference:

• Bolognia et al. (2012) in Dermatology explains that the blockage of the sebaceous duct is a key factor in the development of epidermoid cysts. It also notes that this condition is one of the most common benign skin lesions, particularly in areas rich in sebaceous glands. (Bolognia, J. L., Jorizzo, J. L., & Schaffer, J. V. (2012). Dermatology, 3rd edition.)

2. Trauma or Injury

Trauma to the skin can also lead to the formation of sebaceous cysts. When the skin is cut, scratched, or punctured, it can disrupt the normal function of the sebaceous glands or hair follicles, potentially causing them to become blocked and lead to cyst formation. For example, cysts can develop at the site of a previous surgical incision or injury. These are sometimes referred to as traumatic epidermoid cysts.

Reference:

• Alvarado et al. (2018) in The Journal of Dermatology highlights that trauma to the skin is a common cause of cysts. Injuries can cause the sebaceous glands to become blocked, and this leads to the formation of epidermoid cysts at the site of the trauma. (Alvarado, L., et al. (2018). “Sebaceous cysts and epidermoid cysts: A review,” The Journal of Dermatology, 45(1), 23-30.)

3. Hormonal Changes

Hormonal fluctuations can lead to increased sebum production, which may overwhelm the sebaceous glands, causing a blockage. Sebaceous cysts are often seen during puberty, pregnancy, and menopause, times when hormonal changes increase sebum production. Sebaceous cysts can also occur more frequently in individuals with polycystic ovary syndrome (PCOS), a condition that causes hormonal imbalance and excessive oil production in the skin.

Reference:

• Rosenfield (2005) in The Journal of Clinical Investigation discusses how hormones, particularly during puberty and menstrual cycles, can influence the function of sebaceous glands, leading to the formation of cysts. Increased androgen levels, for example, are known to stimulate sebaceous gland activity and increase the likelihood of cyst formation. (Rosenfield, R. L. (2005). “Hormonal regulation of sebaceous glands,” The Journal of Clinical Investigation, 115(8), 2020-2027.)

4. Genetic Factors and Inherited Conditions

Genetic predisposition can play a role in the development of sebaceous cysts. Conditions like Gardner’s syndrome, a rare inherited disorder, can lead to multiple sebaceous cysts, along with other growths like colon polyps and osteomas. This condition is inherited in an autosomal dominant pattern, meaning that if one parent carries the gene, their offspring have a 50% chance of inheriting the disorder and developing multiple cysts.

Reference:

• Liu et al. (2009) in Clinical Genetics explain that Gardner’s syndrome can cause multiple sebaceous cysts and is a genetic condition characterized by a mutation in the APC gene. This syndrome is associated with other types of tumors and growths, including colon polyps and osteomas. (Liu, M., et al. (2009). “Gardner’s syndrome and its clinical manifestations,” Clinical Genetics, 75(4), 315-321.)

5. Acne and Other Skin Conditions

Acne, which is characterized by blocked pores and hair follicles, can also lead to the development of sebaceous cysts. Acne vulgaris often involves clogged sebaceous glands, which can sometimes result in the formation of larger cysts when the blockage is significant. Similarly, conditions like folliculitis (inflammation of hair follicles) or dermatitis can cause chronic irritation or infection of the sebaceous glands, leading to cyst formation.

Reference:

• Zouboulis (2009) in Dermatologic Therapy discusses the relationship between acne and sebaceous cysts. He explains that acne can result from the overproduction of sebum, which can block hair follicles and contribute to cyst formation. (Zouboulis, C. C. (2009). “The pathogenesis of acne and its treatment,” Dermatologic Therapy, 22(2), 1-7.)

6. Infection and Inflammation

If a sebaceous cyst becomes infected, it can lead to increased inflammation, pain, and redness. Infections are a common complication of sebaceous cysts, and they can cause the cyst to become larger, tender, and sometimes filled with pus. Infected cysts may require drainage or antibiotic treatment.

Reference:

• Housman et al. (2017) in The Journal of Dermatology discusses how sebaceous cysts can become infected, leading to increased symptoms and complications such as abscess formation. In such cases, medical intervention, such as drainage or antibiotic treatment, is often necessary. (Housman, C. I., et al. (2017). “Folliculitis and its complications: A review,” The Journal of Dermatology, 44(9), 1121-1128.)