Sebaceous cysts are common, may be located anywhere on the body,
and frequently become infected. Patients will often present complaining
of pain. The Emergency Physician must be acquainted with the principles
involved in treating abscesses, particularly if they are located
on cosmetically important areas such as the face.
Sebaceous cysts are the result of obstruction of sebaceous gland
ducts. They are freely mobile, round, and located in the subcutaneous
tissues. The cysts are made of a thin white capsule filled with
a thick, cheesy, and keratinous material. They frequently become
infected and subsequently form an abscess. Sebaceous cysts may be
present for many years before infection occurs. Physical examination
often reveals a subcutaneous mass that is fluctuant and tender.
The overlying skin may appear normal or erythematous.
The initial treatment of an infected sebaceous cyst is incision
and drainage. The sebaceous material is
too thick to allow for spontaneous drainage and it must be expressed. The
sebaceous cyst will likely recur, however, unless the capsule of
the cyst is removed. Patients may have the initial incision and
drainage performed in the Emergency Department with follow-up at
some later date to remove the cyst capsule. Alternatively, the cyst
capsule may be removed at the time of the initial incision and drainage.
Incision and drainage is indicated whenever a patient presents
with a tender sebaceous cyst consistent with abscess formation.
The procedure will relieve the patient’s pain. Antibiotics
alone are ineffective in treating abscesses.1 The vast
majority of infected sebaceous cysts may be drained in the Emergency
Department, clinic, or office setting. A noninfected sebaceous
cyst may be removed electively and for cosmetic purposes in the
clinic or office setting by the Primary Care Provider or a Surgeon.
There are no absolute contraindications to the incision and drainage
or removal of an infected sebaceous cyst. Incision and drainage
is preferred if the overlying skin is cellulitic. The capsule can
be removed at a later time. Extremely large abscesses or those in
which adequate anesthesia is not possible should be managed in the
Operating Room by a General Surgeon or Plastic Surgeon. Refer patients
with noninfected sebaceous cysts to their Primary Care Provider
or a Surgeon for removal.
- Povidone iodine solution
- 10 mL syringe
- 25 to 30 gauge needle, 2 inches long
- Local anesthetic solution, with or without epinephrine
- #11 scalpel blade on a handle
- #15 scalpel blade on a handle
- Curved hemostat
- Iris scissors
- Ribbon gauze, plain or iodinated
- 4×4 gauze squares
- Adhesive tape
- Sterile saline
- Nylon sutures for skin closure, various sizes
Explain the risks, benefits, and potential complications of the
procedure to the patient and/or their representative. The
post-procedure care should be explained as well. Document the discussion
of the risks and benefits of the procedure. Obtain an informed consent
for the procedure.
Local anesthesia should be administered,
recognizing that ...