Cysts (Epidermoid, Pilar, etc.)
Symptoms
Cysts are closed sacs under the skin that contain keratin or sebum. They typically present as firm, round lumps that move slightly under the skin and may have a central punctum (visible opening). Common sites include the scalp, back, face, and neck. Cysts may remain small or gradually enlarge. When inflamed or infected, they can become red, tender, and filled with pus, resembling an abscess. They may rupture, draining foul-smelling material. Recurrent swelling and pain are common in untreated cysts. Most are benign and slow-growing.
Cause
Cysts form when hair follicles or oil glands become blocked, trapping keratin or sebum under the skin. Trauma, acne, or irritation can contribute to their formation. Epidermoid cysts arise from the outer layer of skin, while pilar cysts develop from hair follicles—often on the scalp. They are not caused by infection and are not contagious. People with oily skin or a family history may be more prone to cysts. Hormonal factors and poor skin hygiene can play a role, especially in acne-prone individuals.
Treatment
Treatment depends on the size, location, and symptoms. Asymptomatic cysts can be left alone. Inflamed or infected cysts may require drainage and antibiotics. Definitive treatment involves surgical excision of the entire cyst wall to prevent recurrence. Simple drainage without removal often results in regrowth. Procedures are typically done in-office with local anesthesia. Ruptured cysts may leave scars if not properly treated. Avoiding squeezing or popping cysts can prevent infection and scarring.
Dr. Beth Schulz-Butulis
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