Sebaceous cysts are relatively common in occurrence, breaking out in a significant percentage of individuals all over the world annually. Also known as skin cysts, this actually does not cause other symptoms normally, but more attention is paid because of its location. Individuals pay a lot of attention to visible symptoms of problems on the face or on the torso. Skin cysts on the body can be removed/treated effectively, without the need for major medical procedures or lengthy hospitalization. Simple procedures that do not take too much of time is all that is required for managing the condition. Here is a look at all that you need to know about sebaceous cysts, symptoms, causes and various treatment methods available.
Most common locations for formation of the skin cyst
The most common locations for the formation of these skin cysts are the face, torso and the neck. Typically, these cysts are not accompanied by pain or other symptoms. It is very rare for pain or other symptoms to be experienced along with skin cysts. Commonly known as sebaceous cyst, it can be treated by a medical professional without the need for complicated laboratory tests or are diagnostics that involve imaging. It is easy to diagnose, and in most cases can be confirmed by the individual though self diagnosis. It typically takes a few months at the maximum, for resolving the condition. It is mainly caused as a result of blocked glands in the skin or possible trauma related formation. It is easily identifiable by virtue of the lump type formation with a black head in the centre. The possibility of pus formation is high and also depends on the location of the cyst.
What is the sebaceous gland?
As the skin cyst is referred to as the sebaceous cyst, it is important to understand a little more about the sebaceous gland. The sebaceous gland is present all over the entire body of mammals, specifically in the skin. The only place where these glands are not present on the body are the palms of hands and soles of feet. In other words, the sebaceous glands are not present on the skin where hair follicles are absent. The heaviest concentration of sebaceous glands is on the face and the scalp. This oil producing gland is small and typically attached to hair follicles. These glands release sebum which makes its way to the surface of the skin through what is known as the follicular duct.
The function of the gland is to secrete sebum which is responsible for maintaining the flexibility of the skin and for the slightly oily nature of the skin’s surface. This mixture of squalene, cholesterol, wax and triglycerides is collectively known as sebum. This is an important function and helps to maintain skin tone and texture by balancing the absorption of water by the skin. The lubrication as a result of sebum in the skin, helps protect it from damage as a result of friction. Additionally, this also helps in transportation of antioxidants on the skin, apart from offering a shroud of protection to natural light. Sebum is an important constituent, helping the wound healing process, with intrinsic antibacterial properties. It also possesses proinflammatory properties as well as anti-inflammatory properties, which are used effectively in the skin, as required.
Interestingly, these glands shrink and grow again during various stages of development. At childbirth the glands are large in size, which then shrink during childhood. The glands again enlarge during puberty. The levels of testosterone are known to have an impact on the year in which the glands mature.
These glands are also responsible for acne vulgaris which is one of the most common skin disorders among youngsters. Acne vulgaris refers to the condition when the skin gets clogged around the gland, permitting accumulation of sebum. Consequently, this results in the formation of lesions accompanied by inflammation. By virtue of being responsible for acne outbreak, sebaceous glands are known as the sites of origin of acne.
Common causes for formation of sebaceous cysts
The formation of the sebaceous cysts is attributed to either blockage or damage of the duct or the gland. One of the reasons for this blockage/damage is some kind of trauma that could occur externally. Other reasons include skin conditions, for instance acne. It can sometimes be challenging to understand the consequences of certain surgical wounds or scratches that result in the formation of sebaceous cysts. This is mainly because of the slow growth of the cyst, which typically takes many weeks and months before the cyst actually forms as a result of the blockage or damage. Conditions other than trauma that are responsible for the formation of the sebaceous cyst includes – deformity in the duct, or inherited conditions. Common inherited conditions that are attributed to the formation of the skin cysts include basal cell nevus syndrome/gardner’s syndrome.
Overview of sebaceous gland carcinoma
In the context of sebaceous cyst it is essential to know a little more about a rare type of skin cancer. Sebaceous gland carcinoma is attributed to benign adenomas that are commonly known as non cancerous lumps. The reasons for this condition is also attributed to constant exposure to radiation as a result of radiotherapy for other treatments. Another less probable reason is exposure to very frequent X-ray diagnosis. However, this is extremely rare and it is not as common as exposure to radiation. Another reason for sebaceus gland carcinoma is inherited syndrome that is known as Muir Torre condition. This effectively means that the individual with this condition has primary cancer in some part of the body. When symptoms indicate that the patient is a probable candidate of Muir Torre syndrome, the patient is generally made to undergo diagnosis for detecting cancer elsewhere in the body. In a significant number of cases, this additional round of diagnosis is primarily meant for eliminating the reasons for the condition or for confirming the reason. Sebaceus gland carcinoma is regarded as cancer that grows very slowly and it is not known to generally spread to other parts of the body, quite unlike other cancers. Statistically, only 20% of cases of this type of cancer is known to spread to other parts of the body. This is basically a very rare form of cancer, and requires treatment by a specialist team comprising an oncologist, dermatologist and a plastic surgeon. Treatment typically involves complete removal of the cancer including removing border tissue surrounding the tumor, which could be actually be healthy tissue. The reason behind removal of healthy tissue surrounding the cancer is to prevent the relapse, chances of cancer returning. In most cases it is highly unlikely for the surgeon to be able to exactly determine the extent of the cancer. It is only during the time of surgery that the extent of the cancer is actually known. In certain cases it is also possible that the cancer may be present in multiple adjoining locations. Consequently it may be necessary to remove more issue than previously expected. The use of radiotherapy in place of surgical removal is also an option. In some cases, radiotherapy may be used as an additional treatment method on conclusion of operation. Patients who have undergone some kind of treatment for cancer will require follow up visits for many years after the treatment. The purpose of these follow-up visits is to examine, and understand if there are indications of a relapse.
Typical methods of diagnosis used for determining presence of sebaceous cyst
Diagnostics for the presence of sebaceous cyst typically includes physical examination. Additional tests or diagnostics are involved only when the doctor has reason to believe that the cyst requires further tests. This is mainly for the purpose of ruling out or confirming the presence of cancer. In a very small number of cases, additional tests are performed when surgical removal of the cyst appears to be complex or complicated. Some of the more common test that are used as additional tests for sebaceous cysts, include CT scan, punch biopsy and ultrasound screening. Specialists rely on CT scan results to determine the best method for performing surgery and to detect additional issues that may require attention. The purpose of punch biopsy is to carry out detailed examination of tissue that is removed from the cyst. This examination, performed in a laboratory helps to conclusively determine the presence or absence of cancer in the cyst. Ultrasound screening is used primarily to identify the cyst and its constitution.
Removal of sebaceous cyst
Removal of sebaceous cyst is recommended when the cyst begins to cause problems. This could be either because of the onset of some infection, or because of the actual position of the cyst which impacts routine actions. The removal is performed by a specialist and involves the use of a local anaesthetic. The procedures involved ensure that the infection does not spread. Similarly, the procedure is also performed in such a manner so as to prevent the onset of any infections. The antiseptic procedures and preparation of the area involves use of sterile kits by specialists. The removal is performed using specific instruments for incision and removal. Depending on the nature of the system and the underlying infection, it may be necessary to drain the infection. After the procedure is completed, most patients are prescribed a course of antibiotics to manage or prevent the infections.
Cysts that are small in size are also removed by a procedure known as lancing. This refers to the use of sharp instruments to prick and drain abscesses that have soft centres. Most specialists who perform cyst removal, attempt complete removal. This is because whenever a portion of the cyst or wall of the sac remains, the probability of a cyst formation increases manifold. The procedure is likely to leave a scar depending on the size of the cyst and the manner of removal. Actual excision of cyst is never performed when there is inflammation around the cyst. Removal is attempted only after the inflammation has sufficiently subsided. It is also possible that medication would be used for control and management of the inflammation prior to the removal of the cyst.
What happens when infections occur along with the cysts?
Cysts that are infected can be easily diagnosed. Changes in appearance and formation are the visible symptoms of an infected cyst. For instance, reddish appearance is highly likely as a result of the inflammation. Similarly the cyst can also appear whitish in nature, which indicates the formation of pus inside the cyst. The formation of pus is generally accompanied by malodors. The treatment of infected cyst at home typically involves simple remedies. For instance, the area needs to be frequently cleaned with a mild soap that has strong antimicrobial properties. The area should be free from any cosmetic application. The use of a warm compress will help to alleviate the condition and help treat the infection. The best method is to seek medical advice and take a course of prescription antibiotics. There are various preventive methods that need to be followed to ensure that the condition is not aggravated. For instance it is important to overcome the urge to use physical pressure on the cyst. The most common action of individuals is to try and squeeze the cyst, in an ill-informed effort to remove the cyst. Others are known to rub aggressively on the cyst especially when it is infected. Picking or pricking of the cyst with non sterile sharp objects is also common practice among individuals who wish to quickly get rid of the abscess. All of these actions are most likely to result in aggravation of the condition/infection. It could also result in an increase in the pain experienced from the area, apart from increasing the size of the infected area. The best method of handling a cyst, (with or without an infection) is to seek medical advice. A trained specialist is better equipped to fully understand the underlying conditions and initiate/recommend proper action to treat the cyst and the infection. One of the most important outcome of relying on medical assistance, is the prevention of unwanted complications.
Types of removal methods
The removal methods are broadly classified into three different categories. Each method is equally effective and is used on the basis of the condition of the cyst. The decision to use a particular method will rest entirely on the specialist, who will determine and choose the most suitable method as per the condition. The three different types of removal include conventional excision method. In this method, the cyst is completely removed, but is known to leave a long scar upon removal. This is why this method is generally called as the conventional wide excision method. Specialists generally use this method, only in those portions of the body that are not outwardly visible. The second method is the minimal excision method which leaves a very negligible scar. This scar can be cosmetically covered or managed effectively so that it is not visible. However, by virtue of the method of removal the possibility of some tissue still remaining exists. Consequently, there is a possibility of the cyst returning at some point of time. This method is generally used when there is a need to remove the cyst from portions of the body that are very easily seen. The third method used for removal of the cyst is the laser method with punch biopsy, which relies on the use of a laser to drain the contents of the cyst. This is a combination method, where the cyst is emptied of its contents first, following which the outer wall of the cyst is removed later. The gap between the draining of the contents and the removal of the outer wall depends on various conditions such as the size of the cyst and the outer wall. Topical antibiotics are generally recommended by specialists after the removal of the cyst. The purpose of using topical antibiotic formulations is to prevent the outbreak of infections. These topical formulations are used after the procedure till complete healing is achieved. Depending on the type and size of the scar it is also possible that the patient will have to use creams for managing the scars.
Latest advances in cyst removal
While the main techniques that are generally used for removal of cysts are explained above, a new technique has been found to be extremely successful in scar removal. This method is proven to be one of the most effective methods for removal, leaving only a very tiny scar. This is considered as a good choice for removal of a cyst that does not have any kind of infection. It is also suitable for removal of cysts of that are either large in size or present in locations where the skin is thick. In the event that a cyst has to be removed from a location where the skin is stick, there is every possibility of such removal causing a deep scar. In such instances, removal of cyst in this method is regarded as the most suitable option.
This is typically performed by first locating the middle of the cyst. The procedure involves the use of a carbon dioxide laser which punctures multiple holes in the cyst. The contents of the cyst are then removed by the application of pressure and with a squeezing motion. Where the contents of the cyst are hard in nature, the same is removed carefully through surgical scraping instruments. This is performed without damaging the wall of the cyst in anyway. The empty portion is cleaned thoroughly with suitable solutions and the wall of the cyst is sterilized completely with povidone iodine. Open wound is then sutured following which the patient is recommended to apply topical antibiotics and/or take oral antibiotics. As a result of the laser treatment, the size of the cyst is considerably reduced, making it easy for the removal of the cyst wall. Approximately four weeks after the emptying of the contents of the cyst, the wall of the cyst is completely removed. The excision that is necessary for removal of the cyst wall actually heals naturally in a very short period. One of the advantages of this method is the absence of scar as a result of reduction in size of the cyst. Documented studies about the efficacy of this procedure has revealed that complications have not been reported in this method. Interestingly, the size of the scar on the cyst wall, was just one third of the actual size of the cyst when it was first emptied of its contents. This method mandates the removal of the cyst wall including the cyst lining to prevent relapse. Distinct advantages of this method includes the use of the laser which is relatively easy to handle for best results. The use of the laser for punching holes ensure that bleeding is considerably reduced. As a result of this, the specialist gets better visibility of the cyst and the contents. This also reduces the possibility of infection. By reducing the contents of the cyst and its size, it presents a better opportunity for removal of the outside cystal wall with full visibility. This significantly reduces the possibility of leaving out tissue, in addition to greatly reducing the size of the scarring. As mentioned above, the size of the actual scar has been recorded to be just one third of the size of the original cyst. This method has been proven to be one of the most suitable and convenient methods for removal of cysts that are large in size, without any infections.
Other types of sebaceous cysts
There are basically two types of sebaceous cysts, and the reference to a sebaceous cyst could be to either of the two types. The first type is the epidermal cyst, which is also known as an epidermoid cyst. It is sometimes also referred to as the infundibular cyst. The second type of cyst is the pilar cyst which is also known as the trichilemmal cyst. Another term used for describing this cyst is the isthmus-catagen cyst. It is important to understand that both of the cyst types do not contain sebum and are also not a part of the sebaceous gland. The first type of cyst is formed in the epidermis while the second type is formed in the hair follicles. From a technical perspective, these cysts are not actually sebaceus cyst. The actual sebaceous cyst is one that traces its origins to the sebaceous glands, and comprises sebum. This is actually rare and is medically termed as steatocystoma simplex/multiplex depending on the type of occurrence. While one school of thought has advocated the need to avoid using the term sebaceous cyst, due to its misleading nature, the term continues to be used when referring to the above two types of cysts. The possibility of formation of the cyst is more in areas with heavier hair concentration. This is precisely why the cyst is responsible for hair loss when the condition lasts for a long time. The mass of tissue in the system comprises fluids, fibrous tissues and fatty substance. This fatty substance which is keratinous in nature often has a malodor associated with it. In addition to this the cyst also contains a viscous fluid that is a mix of pus and blood. The actual contents of the cyst are determined by the presence or absence of infection of the cyst and/or its surrounding tissue. Proper surgical excision can completely remove the cyst, which will ensure that the cyst will not grow back. However if the exception is not good enough or if infection has caused the cyst to attach itself to adjoining tissue it could be complicated.
Precautions and homes remedies for sebaceous cyst
There should be no attempt to remove a cyst or squeeze it, in the hope of removing it permanently. It is always important to use the services of a qualified medical professional for managing or removing sebaceous cysts. There are multiple home remedies that can be used for managing a cyst. However it is important to understand that this is not an alternative to surgical removal.
Education: Master’s in Clinical Nutrition from Tufts University. Experience: 6 years of experience as a registered dietitian and freelance writer, creating content on nutritional science and weight management for various health websites.
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