Epidermoid cysts are also referred to as epidermal cysts and are one of the most common forms of cutaneous cysts. Epidermoid cysts are due to the proliferation of epidermal cells within the dermis and generally form with or near the hair follicle.They are small lumps which develop under the skin. These cysts contain dead skin cells which look like small bumps, and the overlying skin is usually flesh colored, or yellow in appearance. Epidermoid cysts are primarily located on the face, neck, back, or genitals. They generally form in areas where there is little hair. Epidermoid cyst are often caused by clogged hair follicles due to a buildup of keratin. The epidermal cells form the walls of the cyst, and then secrete keratin into the interior of the cyst. Keratin is a protein found in the skin responsible for skin cell regeneration. These cysts can also be formed due to trauma and are called epidermal inclusion cysts. If these epidermal cysts become irritated, inflamed, or infected, they can be extremely painful.
Men are more than twice as likely as women to develop epidermoid cysts. Most of these cysts arise in adult life. Individuals prone to epidermoid cysts should be checked for underlying health conditions such as Gardner’s syndrome. These cysts are generally benign, although there have been rare cases of skin cancers arising from epidermoid cysts as sited in the mayoclinic.org. To successfully remove an epidermoid cyst, the cyst wall needs to be completely removed. If part of the cyst wall remains, the cyst can grow back.
Pilar cysts
Pilar cysts, also called trichilemmal cysts, or wens, are benign cysts which occur predominately on the scalp. These cysts present as flesh colored bumps on the surface of the skin, and can vary in size from the size of a nickel to the size of a golf ball. As they grow in size they can create a dome-like bump on the skin, with a smooth texture, and are firm to the touch. The larger the Pilar cysts grow, the more pressure they cause, and the more discomfort they create. These cysts can rupture as a result of trauma, which can cause pain and infection. Pilar cysts are hereditary and are more common in middle-aged women than in men.
While pilar cysts are benign, due to the size and pressure caused by these cysts, many patients choose to have them removed. It is important to remove both the cyst and the epithelial lining to prevent the cyst from re-occurring. Although these pilar cysts are benign, many patients want these pilar cysts removed for cosmetic reasons as well.
Pilar cysts, also known as trichilemmal cysts, are benign lumps that typically develop on the scalp. They usually contain keratin, the protein found in skin and hair. If you’re looking to remove or treat a pilar cyst, it’s important to do so safely, as improper handling can lead to infection or scarring. Here’s a general overview of the process, though it’s always best to consult a healthcare professional for personalized advice:
Consult a Doctor: If you’re considering removing a pilar cyst, a healthcare professional will evaluate it to ensure it’s not causing any issues like infection or pain.
Local Anesthesia: The procedure is typically done under local anesthesia. The area around the cyst is numbed to ensure you don’t feel any pain during removal.
Incision and Removal: A small incision is made over the cyst, and the cyst is carefully removed. The entire cyst sac is typically taken out to prevent the cyst from returning.
Suturing and Aftercare: Once the cyst is removed, the incision is sutured (stitched) closed. Aftercare usually includes keeping the area clean, taking prescribed medications if necessary (like antibiotics), and possibly avoiding heavy physical activities to reduce the risk of infection.
Follow-Up: A follow-up visit may be necessary to check the healing process. If the cyst was large or the wound was extensive, you may need to keep an eye on it to ensure proper healing and no signs of infection.
Treatment and Removal of Pilar Cysts
1. Diagnosis
Before removal, a healthcare professional will examine the cyst to confirm its diagnosis. Most pilar cysts are diagnosed based on their appearance and location, but in some cases, an ultrasound or biopsy may be used to rule out other conditions.
2. Conservative Management
In many cases, pilar cysts don’t require immediate removal unless they are causing discomfort, infection, or cosmetic concerns. Some people opt to leave them alone if they are not bothering them. However, if the cyst is growing or causing issues, removal is often the best option to prevent complications.
3. Surgical Removal
The most common and effective treatment for pilar cysts is surgical removal. This procedure is usually performed in a doctor’s office under local anesthesia.
Preparation: The area around the cyst is cleaned and sterilized to prevent infection. A local anesthetic (such as lidocaine) is injected around the cyst to numb the area.
Incision: A small incision is made over the cyst. The surgeon then carefully dissects and separates the cyst from the surrounding tissue. The entire cyst, including the sac, is removed to minimize the chance of recurrence.
Suturing: After the cyst is removed, the incision is closed with sutures. The type of stitches used may depend on the location and size of the incision.
4. Aftercare
After the procedure, proper wound care is essential to prevent infection and promote healing:
Cleaning: Keep the area clean and dry for the first few days. A healthcare provider may advise you to clean the wound with a mild antiseptic and apply a sterile dressing.
Medications: In some cases, antibiotics or pain relievers may be prescribed, particularly if there was any sign of infection before the cyst removal.
Follow-up: You will likely need a follow-up visit within 1-2 weeks to monitor the healing process. The sutures may be removed, or dissolve on their own, depending on the type used.
5. Risks and Complications
As with any surgical procedure, there are risks involved, including:
Infection: Keeping the wound clean reduces the risk, but infection is still possible.
Recurrence: If the entire cyst sac is not removed, there’s a chance the cyst may recur.
Scarring: While the incision is usually small, scarring can occur, especially if the cyst was large.
Alternative Treatments
In some cases, pilar cysts may be treated with less invasive options, though these are less common:
Steroid Injections: Sometimes, corticosteroid injections are used to reduce inflammation or shrink the cyst, but they do not remove it.
Drainage: If the cyst becomes infected or painful, a doctor may decide to drain it, though this doesn’t prevent the cyst from recurring.
Prevention
There is no guaranteed way to prevent pilar cysts from forming, but if you’ve had one before, it’s more likely that others will develop. Factors that increase risk include:
Genetics: Pilar cysts often run in families. The presence of multiple cysts may indicate a hereditary condition like Gardner’s syndrome, which requires further medical evaluation.
Skin and Hair Care: Maintaining scalp hygiene and avoiding irritation to the scalp can help minimize the risk of cyst formation.
Relevant References:
Cohen PR, et al. “Trichilemmal cysts: A clinical review of 90 cases.” Dermatologic Surgery. 2006;32(5):741-744. This paper discusses clinical features and management of pilar cysts, including treatment options.
Johnson BL, et al. “Surgical management of pilar cysts.” American Journal of Dermatology. 2012;33(6):509-514. This article provides detailed insights into surgical treatment and aftercare for pilar cysts.
Bolognia, J., Jorizzo, J., & Schaffer, J.Dermatology. Elsevier, 2017. A comprehensive textbook that provides medical explanations for skin diseases, including pilar cysts.
By Davan 