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Sebaceous cysts are common, present with a very benign evolution, may be located anywhere on the body, and frequently become infected. They are most commonly found on the face, neck, and trunk. Sebaceous cysts are usually asymptomatic unless they become infected. The Emergency Physician must be acquainted with the principles involved in treating infected sebaceous cysts, particularly if they are located on cosmetically important areas such as the face.
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Sebaceous cysts are the result of obstruction of sebaceous gland ducts. They are freely mobile, slow growing, round shaped, painless, and located in the subcutaneous tissues. The cysts are made of a thin white capsule filled with a thick, cheesy, and keratinous material. Their size is variable and ranges from less than a quarter of an inch to more than 2 inches. These keratin-containing lesions are usually seen in young and middle-aged adults in relation to a pilosebaceous follicle.1 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.
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The initial treatment of choice 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.
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Incision and drainage in the Emergency Department is indicated whenever a patient presents with a tender sebaceous cyst consistent with an abscess. The procedure will relieve the patient's pain. Antibiotics without drainage are ineffective in treating abscesses.2 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 a Primary Care Provider or a Surgeon.
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There are no absolute contraindications to the incision and drainage or removal of an infected sebaceous cyst. Caution is advised in those patients with bleeding disorders, taking anticoagulants, or with thrombocytopenia. 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. The procedure should be conducted under general anesthesia in the Operating Room if adequate anesthesia cannot be obtained and pain limits the procedure. Refer patients with noninfected sebaceous cysts to their Primary Care Physician, a General Surgeon, or a Plastic Surgeon for removal.
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- Gown, face mask, and gloves
- Povidone iodine or chlorhexidine solution
- 10 mL syringe
- 25 or ...