An epidermal cyst is a firm, slow-growing lump underneath the skin that contains soft, cheesy-like skin secretions. The lesion usually appears on the face, neck, chest, upper back, genitals, or behind the ears.

Causes

Several causes contribute to the development of an epidermal cyst, including:

• Blockage of a hair follicle (a sac in the skin from which hair grows) by skin cells. When an injury to the skin occurs, cells from the surface may block hair follicles located deeper within the skin.

• Damage to a hair follicle in association with acne

• Blockage or defect of the sebaceous gland (a gland near the hair follicle that secretes oily material used to lubricate the skin and hair)

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Acne and skin injuries increase your risk of developing an epidermal cyst.

Symptoms

If you experience any of these symptoms, do not assume it is due to an epidermal cyst. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician.

Symptoms of an epidermal cyst include:

• Small, dome-shaped lump beneath the skin

• Foul-smelling, cheesy-like material draining from the cyst

• Redness or tenderness on or around the cyst if it becomes inflammed

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. In most cases, a doctor is able to accurately diagnose an epidermal cyst based on its appearance. You may be referred to a doctor who specializes in skin disorders (a dermatologist) for further evaluation and treatment.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Surgical excision – surgical removal of the entire cyst, including its contents and cyst wall

Surgical drainage – cutting open the cyst, draining the contents, and removing the cyst wall (There is a chance of recurrence with this method.)

Steroid Injection – injection of steroids into the cyst to reduce inflammation (This will not remove the cyst.)

Antibiotics may be prescribed to reduce the risk of a complicating infection following surgical excision or drainage.

Prevention

There is no way to prevent an epidermal cyst. If any of the cyst wall is left behind after drainage, the cyst may reoccur. If this happens, your doctor may decide to completely remove the cyst using surgery.

RESOURCES:

American Academy of Dermatology
http://www.aad.org

American Academy of Family Physicians
http://www.aafp.org

US National Library of Medicine
National Institutes of Health
http://www.nlm.nih.gov

CANADIAN RESOURCES:

Canadian Dermatology Association
http://www.dermatology.ca/english/

Dermatologists.ca
http://www.dermatologists.ca/index.html

References:

Common benign cutaneous growths: seborrheic keratoses, cherry hemangiomas, and epidermal cysts. American Academy of Dermatology website. Available at: http://www.aad.org/professionals/Residents/MedStudCoreCurr/DCBenignCutaneousG.htm. Accessed September 4, 2005.

Freedberg IM, Eisen AZ. Fitzpatrick’s Dermatology in General Medicine. Vol 1. 5th ed. New York, NY: McGraw-Hill Health Professions Division; 1999: 884-885.

Sebaceous cyst. Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000842.htm. Accessed September 2, 2005.

Odom RB, James WD. Andrews’ Diseases of the Skin: Clinical Dermatology. 9th ed. Philadelphia, PA: WB Saunders Company: A Harcourt Health Sciences Company; 2000: 862-863.

Zuber TJ. Minimal excision technique for epidermal (sebaceous) cysts. American Family Physician. 2002;65(7):1409-1412.