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Epidermoid Cysts (Sebaceous Cysts)


Disease: Epidermoid Cysts (Sebaceous Cysts) Epidermoid Cysts (Sebaceous Cysts)
Category: Dermatological diseases

Disease Definition:

The small bumps that develop just beneath the skin on the face, neck, trunk and sometimes the genital area are called epidermoid cysts, which are painless and slow-growing. Even though epidermoid cysts are usually referred to as sebaceous cysts, however, real sebaceous cysts are much less common than epidermoid cysts.


Epidermoid cysts are surgically removed when they rupture, become infected, or if they’re a cosmetic concern. However, most epidermoid cysts don’t cause any problems and don’t need any treatment.


Although in some very rare cases epidermoid cysts could give rise to skin cancers, however, they are almost always noncancerous.
Epidermoid cysts usually aren’t biopsied unless they have unusual characteristics that suggest a more serious problem.

Work Group:

Symptoms, Causes


Some of the characteristics of epidermoid cysts are:


  • They range in size from a few millimeters to 5 centimeters in diameter, or less than ¼ inch to nearly 4 inches.
  • They are usually white or yellow, though people with darker skin could have pigmented cysts.
  • They are round cysts or small bumps, which are easy to move with fingers.
  • Can occur on any part of the body, including the fingernails, however, they are mostly found on the face, neck and trunk.


In some cases, an epidermoid cyst may have a central opening that’s plugged by a tiny blackhead; this is the remnant of a hair follicle from which the cyst originally formed. A person could squeeze out a thick, cheesy material through this opening; however, they should leave this task to a dermatologist because of the risk of infection and scarring.


Milia are tiny and deep-seated whiteheads that never seem to come to the surface of the skin. These are miniature epidermoid cysts, which are common in men with significant sun damage on their cheeks and temples and in older women. These cysts could be caused or aggravated by long-term use of oil-based creams or consmetics. Occasionally, when infection occurs, someone is likely to experience these signs and symptoms:


  • Redness, swelling and tenderness around the cyst
  • A thick, yellow material draining from the cyst that may have a foul odor.


Sometimes, a small bump may be noticed on the scalp that looks like an epidermoid cyst. These are either trichilemmal or pilar cysts, which have thicker walls and move freely under the skin. Also, the lining of this type of cyst slightly differs from that of an epidermoid cyst.


Although most epidermoid cysts aren’t harmful, however, a person may want to have them removed for cosmetic reasons. Someone should see a doctor in case they have a cyst that:


  • Occurs in a spot that’s constantly irritated
  • Grows rapidly
  • Becomes painful
  • Ruptures


The epidermis, which is the surface of the skin, is made up of an extremely thin, protective layer of cells that the body continually sheds. Usually, epidermoid cysts form when these surface cells move deeper into the skin and multiply, instead of exfoliating normally. It usually occurs in areas that small hair follicles and larger oil glands (sebaceous glands) exist, including upper back, groin, face and neck.


The walls of the cyst are formed by the epidermal cells which secrete the protein keratin, the thick yellow substance that sometimes drains from the cyst into the interior. Some of the factors that could lead to this abnormal proliferation of cells include:


A ruptured sebaceous gland:

Sebaceous glands produce sebum, which is the oil that lubricates the skin and coats each hair shaft. These glands are located just above the hair follicles and are easily ruptured by inflammatory skin conditions, particularly acne, which makes them a likely site for epidermoid cysts.


Damage to a hair follicle:

Each hair grows from a small pocket of modified skin called a follicle located in the dermis, the layer of skin just below the epidermis. Follicles could become blocked by surface cells due to damage from injuries, such as surgical wounds or abrasions.



Some people with basal cell nevus syndrome, which is an inherited disease that leads to several serious defects, could develop epidermoid cysts. These cysts could also develop in people with Gardner’s syndrome, which is a rare genetic disorder that causes growths in the colon.



Epidermoid cysts could cause basal and squamous cell skin cancers in some rare cases. However, this is so rare, and because of that epidermoid cysts aren’t biopsied unless they’re immobile, infected, solid or have other unusual characteristics that suggest a more serious problem. Some of the other complications of epidermoid cysts include:



After a rupture, an epidermoid cyst can become infected, or it could become infected spontaneously.



When a cyst ruptures, it could cause a boil-like abscess that requires prompt treatment.


Genital discomfort:

Painful intercourse and urination could be the result of genital epidermoid cysts.



Even when epidermoid cysts are not infected, they could become tender and swollen. These inflamed cysts are difficult to remove, and treating them will likely be postponed until the inflammation subsides.


Usually, when cysts don’t cause cosmetic or functional problems, they aren’t treated. However, when a cyst becomes infected, inflamed or ruptured, some of the available treatment options are:


Incision and drainage:

During this procedure, a small cut is made in the cyst and the contents are expressed. Despite the fact that this method is quick and easy, however, after this treatment, cysts usually recur.


Corticosteroid injections:

When a cyst is inflamed but not infected, in order to reduce the inflammation, the cyst may be injected with a corticosteroid.



A carbon dioxide laser could be used in order to vaporize an epidermoid cyst on the face or other sensitive areas to minimize scarring.


Total excision:

This procedure prevents recurrence because it removes the entire cyst. This procedure will be more effective if the cyst is not inflamed. A person may first be recommended treating the inflammation with antibiotics, steroids, or incision and drainage. After four to six weeks, when the inflammation clears up completely they may be recommended to perform excision. This procedure requires sutures, which will be removed within a week or so of total cyst excision in the face; and within one to two weeks, if the sutures are somewhere else on the body.


Minimal excision:

This procedure is thought to be better than total excision because it removes the whole cyst wall and causes minimal or no scarring. During this procedure, a tiny incision is made in the cyst, the contents are expressed and the cyst wall is removed through the incision. Usually the small wound heals on its own.


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