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Sebaceous cyst
Classification and external resources

ICD-10
Epidermoid cyst L72.0,
Pilar cyst L72.1
ICD-9 706.2
DiseasesDB 29388
MedlinePlus 000842
MeSH D004814
A sebaceous cyst /sbes sst/ is a general term that is used to refer to either:
[1]

Epidermoid cysts (also termed epidermal cysts, infundibular cyst; and classified in
ICD-10 as L72.0), or
Pilar cysts (also termed trichelemmal cysts, isthmus-catagen cysts; and classified in
ICD-10 as L72.1).
However, the above types of cyst contain keratin, not sebum, and neither originates from
sebaceous glands (epidermoid cysts originate in the epidermis and pilar cysts originate from
hair follicles). Therefore strictly speaking they are not sebaceous cysts.
[2]

"True" sebaceous cysts (i.e. cysts which originate from sebaceous glands and which contain
sebum) are relatively rare and are known as steatocystomas or, if multiple, as steatocystoma
multiplex.
It has therefore been suggested that the term sebaceous cyst, when used to refer to epidermoid
cysts and pilar cysts, should be avoided since this is misleading.
[3]:31
In practice, however, the
terms are still often used interchangeably.
Contents
1 Epidermoid cyst
2 Pilar cyst
3 Presentation
4 Causes
5 Treatment
o 5.1 Surgical
6 References
7 External links
Epidermoid cyst
Main article: Epidermoid cyst
Pilar cyst
Main article: Pilar cyst
About 90% of pilar cysts occur on the scalp, with the remaining sometimes occurring on the
face, trunk and extremities.
[4]:1477
Pilar cysts are significantly more common in females, and a
tendency to develop these cysts is often inherited in an autosomal dominant pattern.
[4]:1477
In
most cases, multiple pilar cysts appear at once.
[4]:1477

Presentation

This section does not cite any references or sources. Please help improve this
section by adding citations to reliable sources. Unsourced material may be
challenged and removed. (October 2011)

Close-up of an infected sebaceous cyst that has abscessed, located behind the ear lobe.
The scalp, ears, back, face, and upper arm, are common sites for sebaceous cysts, though they
may occur anywhere on the body except the palms of the hands and soles of the feet. In males
a common place for them to develop is the scrotum and chest. They are more common in
hairier areas, where in cases of long duration they could result in hair loss on the skin surface
immediately above the cyst. They are smooth to the touch, vary in size, and are generally
round in shape.
They are generally mobile masses that can consist of:
Fibrous tissues and fluids,
A fatty (keratinous) substance that resembles cottage cheese, in which case the cyst
may be called "keratin cyst" This material has a characteristic "cheesy" or foot odor
smell,
A somewhat viscous, serosanguineous fluid (containing purulent and bloody
material).
The nature of the contents of a sebaceous cyst, and of its surrounding capsule, will be
determined by whether the cyst has ever been infected.
With surgery, a cyst can usually be excised in its entirety. Poor surgical technique or previous
infection leading to scarring and tethering of the cyst to the surrounding tissue may lead to
rupture during excision and removal. A completely removed cyst will not recur, though if the
patient has a predisposition to cyst formation, further cysts may develop in the same general
area.
Causes
Blocked sebaceous glands, swollen hair follicles,
[5]
and excessive testosterone production will
cause such cysts.
[6]

A case has been reported of a sebaceous cyst being caused by the human botfly.
[7]

Hereditary causes of sebaceous cysts include Gardner's syndrome and basal cell nevus
syndrome.
Treatment

This section needs additional citations for verification. Please help improve this
article by adding citations to reliable sources. Unsourced material may be challenged
and removed. (September 2007)
Sebaceous cysts generally do not require medical treatment. However, if they continue to
grow, they may become unsightly, painful, infected, or all of the above.
Surgical
Surgical excision of a sebaceous cyst is a simple procedure to completely remove the sac and
its contents.
[8]


A sebaceous cyst that has been surgically removed.
There are three general approaches used: traditional wide excision, minimal excision, and
punch biopsy excision.
[9]

The typical outpatient surgical procedure for cyst removal is to numb the area around the cyst
with a local anaesthetic, then to use a scalpel to open the lesion with either a single cut down
the center of the swelling, or an oval cut on both sides of the centerpoint. If the cyst is small,
it may be lanced instead. The person performing the surgery will squeeze out the keratin
surrounding the cyst, then use blunt-headed scissors or another instrument to hold the incision
wide open while using fingers or forceps to try to remove the cyst intact. If the cyst can be
removed in one piece, the "cure rate" is 100%.
[citation needed]
If, however, it is fragmented and
cannot be entirely recovered, the operator may use curettage (scraping) to remove the
remaining exposed fragments, then burn them with an electro-cauterization tool, in an effort
to destroy them in place. In such cases the cyst may recur. In either case, the incision is then
disinfected and, if necessary, the skin is stitched back together over it. A scar will most likely
result. In some cases where "cure rate" is not 100% the resulting hole is filled with an
antiseptic ribbon after washing it with an iodine based solution. This is then covered with a
field dressing. The ribbon and the dressing are to be changed once or twice daily for 710
days after which the incision is sewn up or allowed to close by secondary intention, i.e. by
forming granulation tissue and healing "from the bottom up."
An infected cyst may require oral antibiotics or other treatment before or after excision.
An approach involving incision, rather than excision, has also been proposed.
[10]

References
1. "Epidermoid and pilar cysts (previously known as sebaceous cysts)". British
Association of Dermatologists. Retrieved April 2, 2014.
2. "Epidermoid and Pilar Cysts (Sebaceous Cysts) - Patient UK". Retrieved 2013-03-04.
3. Neville BW, Damm DD, Allen CA, Bouquot JE. (2002). Oral & maxillofacial
pathology (2nd ed.). Philadelphia: W.B. Saunders. ISBN 0721690033.
4. Barnes L (editor) (2008). Surgical pathology of the head and neck (3rd ed.). New
York: Informa Healthcare. ISBN 978-0849390234.
5. MedlinePlus Encyclopedia Sebaceous cyst
6. Zuber TJ (2002). "Minimal excision technique for epidermoid (sebaceous) cysts". Am
Fam Physician 65 (7): 140912, 14178, 1420. PMID 11996426.
7. Harbin LJ, Khan M, Thompson EM, Goldin RD (2002). "A sebaceous cyst with a
difference: Dermatobia hominis". J. Clin. Pathol. 55 (10): 7989.
doi:10.1136/jcp.55.10.798. PMC 1769786. PMID 12354816.
8. Klin B, Ashkenazi H (1990). "Sebaceous cyst excision with minimal surgery".
American Family Physician 41 (6): 17468. PMID 2349906.
9. Moore RB, Fagan EB, Hulkower S, Skolnik DC, O'Sullivan G (2007). "Clinical
inquiries. What's the best treatment for sebaceous cysts?". The Journal of family
practice 56 (4): 3156. PMID 17403333.
10. Nakamura M (2001). "Treating a sebaceous cyst: an incisional technique". Aesthetic
plastic surgery 25 (1): 526. doi:10.1007/s002660010095. PMID 11322399.