Epidermal cyst – clogged sebaceous gland

Medically reviewed by The Dermatologists and written by Dr. Alexander Börve

An Epidermal cyst also called sebaceous cyst occurs when the outlet from a sebaceous gland is clogged (blocked pore). As the gland continues to produce sebum, it gradually forms a lump under the skin.

Epidermal cysts occur most commonly on the face, neck, extremities, trunk and scrotum. Most cysts arise in adult life. They are more than twice as common in men as in women. Cysts present as one or more flesh–colored to yellowish, adherent, firm, round nodules of variable size. A central pore or punctum may be present. Keratinous contents are soft, cheese-like and malodorous. Cysts are usually diagnosed clinically as they have typical characteristics. Asymptomatic epidermal cysts do not need to be treated. In most cases, attempt to remove only the contents of a cyst is followed by recurrence. 

In some cases it can be in combination with an inflammation, and the cyst can swell and be painful to the touch. In rare cases they can become infected and an abscess forms. They are rare before puberty.

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Symptoms

Epidermal cysts can occur, because of family history, after surgery, reaction to skin damage, genetic conditions, but most often if there is an underlying skin disease, such as hyperhyidrosis and acne increases the risk.

They are often broad and slightly uneven a rounded resistance that is clearly soft to the touch and elastic in texture and are free to slide around from underneath. They are not usually sore if there is no inflammation or and infection. The size can vary from a few mm to several centimeters and fluctuate in size

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Differentail Diagnosis

Furuncle is a deeper infection that involves the hair follicle with the involvement of the dermis and Subcutis.

Lipoma. Benign, subcutaneous, sometimes intramuscularly located fat knot. Often a slow growth. Usually sits a bit deeper than an epidermal cyst. A superficial lipoma is usually surrounded by a capsule and therefore not movable from surrounding tissue and they usually do not fluctuate in size.

Angio lipoma. Benign subcutaneous change. Rarer. Often multiple and hereditary occurrence. Usually occurs on forearms and breasts at a young age. May be pain to the touch and body strain.

Fibroma. Small, soft connective tissue knuta. Rounded, tab-shaped E T. C. Occurs from the age of 30 and upwards, often on the neck or face. Most are skin colored, more rarely pigmented.

Dermoid cyst. Innate, appears almost always in childhood, not seldom already at birth. Can contain shifting structures at different stages of development, such as teeth and hair. The most common localization are the eyebrows.

Lymphoma. One or more magnified (> 1.5 cm in diameter), lymph glands.

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Should I seek medical care?

They are benign. Seek medical care if they grow, get infected or are painful. Otherwise it is just of cosmetic concern.

Treatment

In case of more pronounced inflammation/infection, the treatment is surgical; Incision and drainage. Whether it is cosmetic or otherwise disturbing and recurring it is surgically treated. It is important that the whole capsule is extracted. 

Antibiotic treatment is very rarely topical; In principle only at more pronounced infected cysts

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Sources:

Hoang, Van Trung et al. “Overview of epidermoid cyst” European Journal of Radiology Open, Volume 6, 291 – 301

Koji Nakajima MD, PhD Ayumi Korekawa MD, PhD Hajime Nakano MD, PhD Daisuke Sawamura MD, PhD “Subcutaneous dermoid cysts on the eyebrow and neck” Pediatr Dermatol. 2019 Aug 14.