Cutaneous cysts: what they are, types and treatment

By Cristiano Antonino On Mar 18, 2023

Cutaneous cysts are benign formations that can be felt under the skin. They are generally round in shape and are due to the occlusion of the excretory duct of a sebaceous gland, which consequently does not eliminate its secretion; hence the formation of the cyst

The contents are generally a foul-smelling liquid, composed of epithelial debris and fatty material.

Although slowly, the cysts can grow over time, reaching dimensions of up to 6 cm and appearing as semi-solid masses to the touch.

Cutaneous cysts are usually asymptomatic, unless they are superinfected or located in sensitive regions, such as on the back.

The diagnosis is very simple and is based on a simple physical examination.

Given the absence of disabling symptoms, skin cysts are often underestimated, however it is good to inquire and inform your doctor if you observe their appearance, so that you can set up an adequate treatment.

Types of cysts

There are various types of cysts, which differ from each other according to the histological characteristics of their walls and their location on the body.

The dimensions are rarely a discriminating factor between the various types, as almost all of them can reach 6 cm; as well as all are generally painless, solid to the touch and globular,

Cutaneous cysts are divided into:

epidermal inclusion cysts, also called epidermoid cysts, usually characterized by the presence of a point or pore visible to the naked eye. They are generally symptomatic, unless they rupture and therefore can become complicated with the formation of an abscess. Their contents are malodorous, cheesy and whitish;
milia cysts are a type of epidermal inclusion cyst, present on the face or scalp, small in size (1-4 mm)
pilar cysts, also called trichilemmal, similar to those from epidermal inclusion but present in 90% of cases on the scalp

Symptoms and signs

Usually the cysts are painless and are not disabling, except for the large ones located in sensitive points, such as the back or the gluteal region; or in clearly visible regions, such as the face.

In the event of a rupture, pain may appear.

The cyst manifests itself with the formation of a rounded swelling, visible to the naked eye, with the appearance of a lump, containing liquid.

These are therefore lesions of semi-solid consistency and mobile in most cases.

Generally, skin cysts form due to the accumulation of keratin, sebaceous or follicular substances under the skin

As previously mentioned, the occlusion of the excretory duct of a sebaceous gland prevents the disposal of waste substances such as dead cells, sebum or keratin.

Skin wounds or pathologies that increase the production of sebum can favor the formation of skin cysts, as can bad habits such as tobacco consumption, alcohol abuse and the use of cosmetics that are not suitable for your skin.

Some genetic diseases such as Gardner’s syndrome or basal cell nevus syndrome are associated with the formation of skin cysts.

A physical examination is usually sufficient to diagnose skin cysts

Through a quick inspection and a light palpation, the dermatologist is able to make a diagnosis and recommend an appropriate treatment.

In more complex cases, the doctor may request further tests in order to exclude more complex pathologies:

ultrasound
CT
biopsy

Treatments and removal

Treatments for skin cysts differ according to the type, size and how disabling they are.

First of all, the doctor could prescribe drugs administered orally or topically, such as antibiotic or cortisone creams.

In cases of large cysts, also in consideration of the aesthetics, drainage or alternatively excision of the mass may be necessary, which involves the removal of the cystic wall in order to prevent subsequent recurrences.

The excision is performed under local anesthesia, through the use of a scalpel, with a small incision and the evacuation of the contents.

Complications

As already seen, the complications include spontaneous rupture which is associated with pain and a predisposition to bacterial infections and therefore abscessisation.

Abscesses are characterized by the presence of purulent, yellowish or greenish, foul-smelling material; they are usually painful and associated with skin redness.

For this reason, in cases of spontaneous rupture of the cyst, the intervention must be carried out immediately, and can include the placement of a drainage gauze to be removed later, in association with antibiotic therapy.

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