Epidermal Inclusion Cysts

Epidermal inclusion cysts, also known as sebaceous cysts, are filled with keratin and lined with stratified squamous epithelium. Epidermal cysts usually occur on the back, face, and chest and open to the skin through a small, central punctum or keratin-filled plug. On the back, these may be deep and barely palpable, whereas on the scalp an epidermal cyst (pilar cyst) can be elevated and freely movable. The cysts may remain small for years or may grow rapidly. Rupture of the cyst wall into the dermis initiates an inflammatory response.

Acutely inflamed, fluctuant cysts should be incised and drained. Destruction of the cyst wall at incision decreases the risk of cyst recurrence. Alternately, the cyst may be removed intact by excision and blunt dissection. Complete drainage is enhanced with gauze packing, changed frequently during wound healing. The use of antibiotics is unnecessary unless a concurrent cellulitis exists. If a patient requests removal of an epidermal cyst before an acute inflammatory event, the cyst wall can be more easily shelled out, minimizing risk of recurrence.

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