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Epidermoid Cyst – Causes, Symptoms and Treatment

An epidermoid cyst (also called a sebaceous cyst) is a benign, sac-like growth beneath the skin caused by blocked sebaceous glands. It is harmless but may require treatment if inflamed.

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Things worth knowing about "Epidermoid cyst"

An epidermoid cyst (also called a sebaceous cyst) is a benign, sac-like growth beneath the skin caused by blocked sebaceous glands. It is harmless but may require treatment if inflamed.

What Is an Epidermoid Cyst?

An epidermoid cyst -- colloquially known in German as a Grützbeutel -- is a benign, slow-growing cyst that develops just beneath the surface of the skin. It forms when dead skin cells and sebum (skin oil) become trapped within a closed sac lined by a thin layer of epithelium. The content of the cyst is typically a white, pasty, cheese-like material that may have a distinctive odor.

Epidermoid cysts are among the most common benign skin growths and can affect people of all ages, though they are most prevalent in adults. They are generally harmless and non-cancerous.

Causes

Epidermoid cysts can develop due to several factors:

Blocked sebaceous ducts: The most common cause is a clogged duct of a sebaceous (oil) gland, preventing normal secretion.
Implantation of skin cells: Minor injuries or trauma can push surface skin cells into deeper layers, where they form a cyst.
Blocked hair follicles: Obstruction of a hair follicle can also trigger cyst formation.
Genetic predisposition: Some individuals are more prone to developing cysts due to their skin type or family history.
Acne and skin conditions: Conditions that affect the sebaceous glands may increase the risk of cyst formation.

Symptoms

The typical features of an epidermoid cyst include:

A round, smooth lump beneath the skin that moves freely when touched
Slow, gradual growth over months or years
A small central punctum (dark pore) may be visible on the surface
Generally painless unless inflamed or infected
If infected: redness, warmth, swelling, tenderness, and possible discharge of pus

Epidermoid cysts can occur almost anywhere on the body but are most commonly found on the face, scalp, neck, back, and genital area.

Diagnosis

Diagnosis is typically made through a clinical examination by a healthcare provider. The characteristic appearance, location, and texture of the cyst are usually sufficient for a confident diagnosis. In uncertain cases, an ultrasound or histological analysis of the removed tissue may be used to rule out other skin conditions or malignant growths.

Treatment

Treatment is not always necessary if the cyst causes no discomfort. However, several options are available:

Surgical Removal

The most reliable and permanent treatment is surgical excision, performed under local anesthesia. The entire cyst, including its capsule, must be removed to prevent recurrence. If the capsule is left behind, the cyst is likely to grow back.

Treatment of Infected Cysts

If the cyst becomes inflamed or infected, the first step is usually incision and drainage to release the pus. Antibiotics may be prescribed to treat the underlying infection. Definitive surgical removal is then typically scheduled after the inflammation has resolved.

What Not to Do

Squeezing or puncturing a cyst at home is strongly discouraged, as this can lead to infection, scarring, and incomplete removal -- meaning the cyst will likely return.

When to See a Doctor

Medical attention is recommended if the cyst:

Grows rapidly or changes in appearance
Becomes red, warm, swollen, or painful
Discharges pus or fluid
Is located in a cosmetically sensitive or uncomfortable area
Cannot be clearly distinguished from other skin lesions

References

Habif, T.P.: Clinical Dermatology -- A Color Guide to Diagnosis and Therapy. 6th ed. Elsevier, Philadelphia 2016.
DermNet NZ: Epidermoid cyst. Available at: https://dermnetnz.org/topics/epidermoid-cyst (accessed 2024).
James, W.D., Elston, D.M., Treat, J.R.: Andrews' Diseases of the Skin -- Clinical Dermatology. 13th ed. Elsevier, Philadelphia 2019.

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