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What are the symptoms of sebaceous cysts?

The presence of a lump or growth under the skin is usually a sign that you may be developing a sebaceous cyst. Sebaceous cyst may initially appear soft, but later grow firmer as the amount of keratin builds up in the wall of the cyst.  Most cysts are benign and completely harmless. At the start, the the cyst is painless, but depending on the location of the cyst, it can become irritated, erythematous, and inflamed. This inflammation can be a sign of an underlying skin infection.  If the cyst becomes tender to the touch and the surrounding skin appears red and warm, the sebaceous cyst may be infected, and will need further treatment. The cyst may need to be opened and drained, allowing the infection to escape, and oral antibiotics will need to be prescribed. When the cyst becomes painful, or the surrounding skin becomes warm with a foul smelling discharge, this is a strong indication of infection. In an infection is left untreated, it can become serious. Fever, or any other systemic symptoms means that prompt medical attention is necessary.

While most sebaceous cysts pose no cancerous threat it cannot be ruled out entirely. A sebaceous cyst may be considered abnormal or possibly cancerous if it’s diameter is larger than five centimeters, or continues to recur in the same location after repeatedly being removed.

What causes a sebaceous cyst?  

Sebaceous cysts are formed within the sebaceous gland, which is the gland which produces sebum. These cysts develop when the hair follicles become clogged due to a build up of sebum or keratin. These cysts can also be formed from pimples or as a result of trauma to the sebaceous glands. Individuals with a genetic predisposition such as steatocystoma multiplex, Gardner’s syndrome or Basal Cell Nevus Syndrome are also prone to developing sebaceous cysts.

1. Blocked Hair Follicles or Sebaceous Glands

The most common cause of a sebaceous cyst is a blockage of the sebaceous gland duct. Sebaceous glands, which are present throughout the skin, except on the palms and soles, secrete sebum (oil) to lubricate the skin and hair. A blockage in the duct can cause this sebum to accumulate and form a cyst.

Mechanism:

• The sebum (oil) produced by the sebaceous glands becomes trapped inside the gland if the duct is blocked.
• Keratin (a protein found in skin cells) may also accumulate, contributing to the cyst’s formation. This combination leads to a swelling or lump under the skin.

Reference:

• Fitzpatrick’s Dermatology in General Medicine (2019) describes the formation of sebaceous cysts as a result of ductal blockage and the accumulation of sebum and keratin. This blockage can occur from a variety of sources such as excess oil production or a clogged pore.

2. Trauma or Injury to the Skin

Physical injury or irritation to the skin can cause a sebaceous cyst to form. Trauma to the skin or surgical incisions may damage the sebaceous glands or block their ducts, leading to cyst formation.

Mechanism:

• Cuts, abrasions, or piercings can disrupt the sebaceous gland’s natural drainage, causing it to become blocked.
• Scar tissue may form and block the ducts, which contributes to the cyst’s development.

Reference:

• The Journal of Clinical and Aesthetic Dermatology (2017) mentions that skin trauma is a common factor that can cause sebaceous cysts to form, especially when sebaceous glands are damaged or obstructed following injury or surgery.

3. Genetic Factors

Some individuals are genetically predisposed to develop sebaceous cysts. Certain inherited conditions, such as Gardner’s syndrome and Pachyonychia congenita, are known to cause recurrent sebaceous cysts.

Mechanism:

• Genetic disorders that affect epidermal keratinization (the process by which the outer skin layer is formed) can lead to abnormal functioning of sebaceous glands, resulting in cyst formation.
• These conditions typically result in multiple sebaceous cysts occurring throughout the body.

Reference:

• American Academy of Dermatology (2021) notes that Gardner’s syndrome, an inherited disorder, is associated with the development of multiple sebaceous cysts, due to abnormalities in skin and sebaceous gland formation.

4. Acne

Acne is a major risk factor for the development of sebaceous cysts. Acne vulgaris causes clogging of hair follicles with dead skin cells and excess sebum, which can create the ideal environment for cyst formation.

Mechanism:

• Acne typically occurs when sebaceous glands become overactive and produce excess sebum, which can mix with dead skin cells and clog hair follicles.
• Blocked pores can lead to pimples or cysts. If the blockage persists, it can evolve into a sebaceous cyst.

Reference:

• According to Dermatology Clinics (2016), acne and other forms of clogged pores increase the likelihood of developing sebaceous cysts. Individuals with severe acne are more prone to cyst formation due to the increased oil production and blockage of follicles.

5. Hormonal Changes

Changes in hormone levels can trigger the formation of sebaceous cysts, as hormonal fluctuations often lead to increased sebum production by sebaceous glands. This is especially common during periods of puberty, menstruation, pregnancy, or hormonal disorders.

Mechanism:

• Increased androgen levels during puberty or pregnancy can lead to an increase in sebum production, which can block sebaceous gland ducts.
• Hormonal disorders such as Polycystic Ovary Syndrome (PCOS), where the body produces excess androgens, can increase the likelihood of sebaceous cyst formation.

Reference:

• The Journal of Clinical and Aesthetic Dermatology (2017) states that hormonal fluctuations contribute significantly to the formation of sebaceous cysts, particularly during puberty, pregnancy, and menstrual cycles.

6. Poor Skin Hygiene

Inadequate or irregular skin care can contribute to the formation of sebaceous cysts, as it can lead to accumulation of oil, dirt, and dead skin cells on the skin’s surface. This accumulation can obstruct the ducts of sebaceous glands, leading to cyst formation.

Mechanism:

• If dead skin cells and oil are not regularly removed through washing, they can accumulate in the pores and block sebaceous glands.

Reference:

• According to the American Academy of Dermatology (2020), poor hygiene, particularly infrequent cleansing, can cause the buildup of excess oil and dead skin, leading to clogged pores and the formation of sebaceous cysts.

7. Excessive Sweating or Friction

Excessive sweating can clog pores, especially in areas where sweat accumulates. Friction from clothing, backpacks, or other repetitive movements may also irritate the skin and block sebaceous glands, leading to cyst formation.

Mechanism:

• Sweat and friction can irritate the skin, increasing the likelihood of pore blockages and causing sebaceous cysts.

Reference:

• British Journal of Dermatology (2019) suggests that excessive sweating and friction are significant contributors to the formation of sebaceous cysts, especially in the back, chest, and underarms.

8. Infection (Rare Causes)

While sebaceous cysts themselves are not caused by infection, they can become infected after they form. Bacteria entering the cyst can cause it to swell, become red, and fill with pus. This can occur if the cyst is ruptured or exposed to bacterial contamination.

Mechanism:

• Bacterial infection can enter the cyst, causing it to become inflamed and filled with pus. This is not a direct cause of cyst formation but a potential complication.

Reference:

• According to the Mayo Clinic (2022), sebaceous cysts are generally benign, but they may become infected, leading to redness, pain, and pus-filled drainage.

9. Chronic Skin Conditions

Certain chronic skin conditions that involve inflammation or excessive oil production can predispose individuals to developing sebaceous cysts.

Conditions:

• Seborrheic dermatitis: A common skin condition causing red, scaly patches and increased oil production, which can clog pores.
• Rosacea: A condition that causes redness and pimples, which can lead to cyst formation in affected areas.

Reference:

• Dermato-Endocrinology (2015) explains that skin conditions like seborrheic dermatitis and rosacea can lead to excessive sebum production and skin inflammation, contributing to the formation of sebaceous cysts.