Okay, let's talk about Epidermoid Cysts, which you might also know as Sebaceous Cysts. I understand that finding a new lump or bump on your skin can be worrying, and I'm here to help you understand what might be going on.

1. Overview

An epidermoid cyst is a small, non-cancerous bump that develops beneath the skin. It's essentially a little sac filled with a cheesy, thick, yellowish material called keratin, which is a protein naturally found in skin, hair, and nails.

These cysts form when skin cells (epidermal cells) that are normally shed from the surface move deeper into your skin and multiply, forming the wall of the cyst and then secreting keratin into the center. This can happen due to a blocked hair follicle or an injury to the skin. Anyone can get an epidermoid cyst, but they are most common in adults. The good news is that epidermoid cysts are not contagious. While they are usually harmless, they can sometimes become inflamed or infected, which can be uncomfortable, and their appearance can sometimes cause concern or affect self-esteem.

2. Symptoms

You might notice a few things if you have an epidermoid cyst. Here are some common signs:

• A small, round bump just beneath the skin, often on the face, neck, chest, or back.
• The cyst usually feels firm or slightly soft and is typically movable under the skin.
• It's often skin-colored, whitish, or yellowish.
• You might see a tiny dark spot or blackhead (called a punctum) in the center of the cyst, which is the opening of the blocked follicle.
• They usually grow very slowly over months or even years.
• Most of the time, they are painless, but they can become tender, red, and swollen if they get inflamed or infected.
• If the cyst ruptures or becomes infected, it might drain a thick, foul-smelling, cheese-like material.
• Friction or pressure on the area can sometimes irritate the cyst.

3. Diagnosis

Diagnosing an epidermoid cyst is usually quite straightforward for a healthcare professional. Most often, a doctor can identify it simply by looking at it and feeling the bump during a physical examination. They'll look at its size, shape, color, and whether it moves freely under the skin.

In some cases, especially if the cyst looks unusual, is very large, grows quickly, or is particularly painful, your doctor might want to be extra sure. They may recommend a biopsy, where a small sample of the cyst wall is removed and looked at under a microscope to confirm it's an epidermoid cyst and not something else.

Management & Treatment

The good news is that many epidermoid cysts don't cause any problems and may not need any treatment at all. Sometimes, they even go away on their own. However, if a cyst is bothering you for cosmetic reasons, or if it becomes painful, red, or swollen, there are several treatment options available.

For a cyst that is inflamed but not infected, a simple and helpful home care strategy is to apply a warm, moist compress to the area for 15-20 minutes, several times a day. This can help to reduce the inflammation and encourage the cyst to drain on its own.

If the cyst becomes tender and swollen, a healthcare provider might recommend an injection of a steroid medication directly into the cyst. This can help to calm the inflammation and reduce the swelling.

For cysts that are infected or very painful, a procedure called incision and drainage may be performed. Your doctor will make a small cut in the cyst and gently squeeze out the contents. While this can provide quick relief from the pain, it's important to understand that the cyst may come back because the cyst wall is left behind.

The most effective treatment for preventing an epidermoid cyst from returning is surgical excision. This involves a minor surgical procedure, usually done in the doctor's office under local anesthesia, to completely remove the entire cyst and its wall. This is the best way to ensure the cyst does not grow back.

Important Safety Warning: It can be very tempting to try and pop or squeeze a cyst yourself, but please resist the urge! Trying to drain a cyst at home can be risky. It can lead to a painful infection, cause the cyst to become more inflamed, and may result in scarring. It's always best to let a healthcare professional handle it to ensure it's done safely and effectively.

If you've had a cyst treated and it seems to be coming back, or if you notice any signs of infection like increasing redness, pain, or pus, it's important to follow up with your doctor.

4. Duration & Outlook

Epidermoid cysts can behave in a few different ways. Some may remain small and unchanged for years, causing no problems at all. Others might slowly get bigger over time. Occasionally, a cyst might go away on its own, but this is less common, and they often can recur, sometimes in the same spot.

These cysts are typically chronic, meaning they can last for a long time unless they are removed. The outlook is generally very good, as epidermoid cysts are benign (not cancerous). The main concerns are cosmetic, or if they become inflamed or infected, which can cause pain and require attention. A key warning sign for complications is if the cyst becomes rapidly larger, very red, warm, painful, or starts to drain pus. If this happens, it's important to see your doctor.

5. Prevention

Unfortunately, there's no guaranteed way to prevent epidermoid cysts from forming. Since they often arise from blocked hair follicles or minor skin injuries, maintaining good skin hygiene might be helpful, but it's not a foolproof method.

If you've had them before, especially if related to acne, managing your acne effectively could potentially reduce the chances of new ones forming in those areas. Try to avoid squeezing or picking at pimples or existing small cysts, as this can sometimes damage the skin and potentially lead to cyst formation or inflammation. Protecting your skin from injury might also play a small role.

6. Causes & Triggers

Epidermoid cysts are primarily caused by the trapping of surface skin cells (epidermal cells) beneath the skin. Instead of shedding off as they normally would, these cells multiply and form a sac, secreting keratin into the center. This can happen when a hair follicle becomes blocked, often by a buildup of skin oils and dead skin cells, or due to damage to a hair follicle or oil gland in the skin, such as from a skin injury like a scratch, a surgical wound, or a skin condition like acne.

While there isn't always a specific "trigger" for a cyst to appear, irritation or injury to an existing small, unnoticeable cyst can cause it to become inflamed and more apparent. Anyone can develop an epidermoid cyst, but they are more common in adults, particularly men. People who have a history of acne are also somewhat more prone to developing them. In rare cases, there can be a genetic predisposition, such as in Gardner's syndrome, but this is not common.

7. When to see a doctor

While many epidermoid cysts don't require urgent medical attention, there are definitely times when it's wise to consult a doctor or dermatologist. It's important to get a proper diagnosis, especially if you're unsure what the bump is.

You should see a doctor if you notice:

• Rapid growth: The cyst suddenly starts getting bigger quickly.
• Signs of infection: The area becomes red, swollen, warm to the touch, or painful. You might also see pus draining from it.
• Rupture: The cyst breaks open, which can lead to inflammation or infection.
• Pain or discomfort: Even without obvious infection, if the cyst is tender or causes pain.
• Location: If the cyst is in a place where it's frequently irritated (like by clothing) or if it's cosmetically bothersome to you.
• Uncertainty: If you're worried about the bump or unsure of what it is, peace of mind from a professional diagnosis is always a good idea.

A dermatologist is a specialist in skin conditions and can provide an accurate diagnosis and discuss if any action is needed. Remember, it's always better to have things checked out if you have any concerns.

8. Frequently Asked Questions (FAQs):

• Q: Are epidermoid cysts (sebaceous cysts) cancerous? A: No, epidermoid cysts are benign, meaning they are not cancerous. However, it's always best to have any new or changing skin lump checked by a doctor to confirm the diagnosis, as very rarely other more serious conditions can look similar.
• Q: Should I try to squeeze or pop my epidermoid cyst? A: It's really best not to try and squeeze or pop an epidermoid cyst yourself. Doing so can push the contents deeper into the skin, leading to inflammation, infection, and potentially a larger, more painful problem or scarring. It can also make it more difficult to treat later if needed.
• Q: Will an epidermoid cyst go away on its own? A: Sometimes a small cyst might resolve on its own, but often they persist or can even slowly grow larger. If they become inflamed, they might shrink after the inflammation subsides, but the cyst sac often remains, meaning it could fill up again in the future.
• Q: What's the difference between an epidermoid cyst and a sebaceous cyst? A: The terms are often used interchangeably, but "epidermoid cyst" is the more accurate medical term. True sebaceous cysts, which originate from sebaceous (oil) glands, are much less common than epidermoid cysts, which originate from skin cells. What most people call a sebaceous cyst is usually an epidermoid cyst.
• Q: Can epidermoid cysts come back after they've been drained or removed? A: If a cyst is only drained (like when it's inflamed and infected), it can certainly come back because the cyst wall or sac that produces the keratin is still there. For a more permanent solution, the entire cyst sac usually needs to be removed. Even then, there's a small chance it could recur, or a new one could form nearby.

Living with any skin concern can be a source of worry, and I hope this information helps you feel more informed. Please remember, this information is for educational purposes, and it's always best to consult with a healthcare professional for a personal diagnosis and advice.

References

• Cleveland Clinic. (2022, March 29). Epidermal Inclusion Cysts (Sebaceous Cysts). Retrieved from https://my.clevelandclinic.org/health/diseases/14165-sebaceous-cysts
• Mayo Clinic. (2023, March 4). Epidermoid cysts. Retrieved from https://www.mayoclinic.org/diseases-conditions/epidermoid-cysts/symptoms-causes/syc-20352701
• DermNet NZ. (2023). Epidermoid cyst. Retrieved from https://dermnetnz.org/topics/epidermoid-cyst