Causes of Sebaceous Cyst

• The sebaceous gland is producing oil at a faster rate than can be released from the gland.
• Sebaceous gland or its duct have become damaged or blocked, causing oil accumulation.
• The sebaceous duct deforms at birth
• Genetic conditions like Gardner’s syndrome or basal cell nevus syndrome.
• Lastly, hereditary conditions like steatocystoma multiplex.

Appearance:

Sebaceous cysts are generally found on the face, neck and abdomen. Moreover, these cysts may remain small or grow large. In fact, their growth is slow and they may disappear without treatment.

A typical cyst -

• Is a small, round lump under the skin.
• Feels harder than normal skin.
• Is usually the same colour as the skin
• Has a small blackhead in the centre called the punctum.
• Is often filled with white flakes of keratin.

Moreover, some of the areas on the body where these cysts can be found are:

• Scalp
• Face
• Neck
• Back

Symptoms:

• Bumps under your skin.
• A red and yellow tint on these bumps
• Bumps around your neck, face, chest, or shoulders
• A foul-smelling liquid oozing from the bump
• Sore and tender skin around the bump

Cysts range from pea-sized, starting at about 1 centimetre and can go up to 5 centimetres. If the cyst has a diameter larger than 5 centimetres, is showing signs of infection, such as redness, pain, or pus drainage, or is recurring really fast after removal, it is necessary to consult a doctor.

In fact, sebaceous cysts usually refer to epidermoid cysts or pilar cysts.

• Epidermoid cysts contain keratin, which is the protein in the top layer of skin and originates from the epidermis. But when the cells move into your skin instead of shedding they result in the formation of epidermoid cysts.
• Pilar cysts also contain keratin and originate from the hair follicles.

Treatments

Cysts are non-cancerous and do not pose any health threats. However, they can be extremely uncomfortable. In general, sebaceous cysts do not require any treatment. Therefore, the most preferred course of action is to keep them clean and not try too many treatments. 

However, if a cyst has burst or there is an infection occurring under the skin, the doctor sometimes needs to lance and drain it. In such a case, the doctor may need to prescribe a course of antibiotics.

• Medication

Dermatologists prescribe medicines like antibiotics & steroids in the form of pills and topical creams or injectables to treat infected sebaceous cysts. These will reduce the inflammation and pain of the cysts. 

• Surgery

After the inflammation reduces, dermatologists remove your cyst by a curette or scalpel, after sanitising the area. They may also stitch the area up. In fact, cysts usually do not recur after this procedure. 

i.Sterilisation: The area to be treated is prepared by sterilizing the surrounding skin with an antiseptic (povidone-iodine) solution, to prevent infection. 

ii.Anaesthesia: A local anaesthetic (2% lignocaine with adrenaline) is injected or applied topically to the site to minimize or prevent pain during the procedure.

iii.Incision: A stab incision is made using a blade into the centre (punctum) of the cyst. 

• Incision and drainage (I&D): 

In this treatment, dermatologists remove the contents of the cyst through a small cut. Although it is fairly quick, easy, and inexpensive, the chances of recurrence are high. 

• Excision:

In this treatment, dermatologists remove the complete cyst wall and its contents. Moreover, they loosen the cyst wall from the surrounding tissues to remove the sac. After that, they remove the cyst wall. Lastly, they apply an antibiotic (betadine) ointment over the incision wound, and a do a dressing. 

There are two types of excision:

i.Total excision: Dermatologists remove the complete sac to prevent the recurrence. In fact, total excision is time-consuming and requires stitches and there is a risk of scarring.

ii.Minimal excision: Dermatologists remove the contents and the cyst wall through a 2-3 mm cut. Moreover, it is less invasive and the wound can heal naturally.