Let’s Talk About Cysts - Appalachian Spring Dermatology

Cysts are a common occurrence on the skin. There are multiple types of cysts. Patients usually have many questions about cysts, so let’s answer some of the most common ones.

What is a cyst? A cyst is a sack under that skin that usually accumulates oil and dead skin. They can grow on any part of the body except the palms and soles. They generally are benign, so not all cysts need to be removed.

What kind of cyst is it, and why did I get it? I’ll address these two questions together. There are three main kinds of cysts – Epidermoid, Sebaceous, and Pilar Cysts. All types of cysts can be seen in similar places. Meaning, not all cysts on the scalp are pilar cysts. We can only scientifically determine what type of cyst it is by microscopically examining the lining of the sack of the cyst.

Epidermoid Cysts -These cysts originate most often from an invagination of the skin from injury or a piercing.

Sebaceous Cysts-These cysts originate as a growth off the oil glands.

Pilar aka Trichilemmal Cysts – These originate as a growth off the hair follicle. These are more common on the scalp but can be seen elsewhere.

Do you remove cysts in the office? Yes, we do, but depending on the size and location of the cyst, we often will have you return to the office on a surgery day when Dr. Rosenberger has ample, focused time.

What does removing a cyst involve? First, for a cyst to be removed in its entirety, the cyst sack needs to be intact. If a cyst is inflamed or ruptured, the sack is not intact, and it cannot be definitively removed. For an intact cyst, we make an incision, or a small hole called a punch biopsy. The sack is then removed through that opening in the skin. The skin is then sutured closed. Sutures are removed 7-14 days later, depending on the area of the body from which the suture is removed.

Do cysts usually recur after they are removed? Cysts that are drained frequently recur. Cysts that are surgically excised with the sack intact are less likely to recur, but in my experience, about 10% of cysts recur. This can be if the entire cyst sack is not removed, a new cyst randomly occurs in the same area, or there may be multiple small cysts in the same area. I have many times encountered multiple small cysts surrounding the larger main cyst during excision.

Should I have my cyst removed or leave it be? Given that cysts are usually benign (99%) and are not bothersome, I often recommend, and most patients choose to leave them alone. Do not squeeze a cyst or try to evacuate a cyst. The only problem with cysts is the risk of rupture. I often liken a cyst to a balloon. As you blow up a balloon, you never know how full it can be until it suddenly pops. It’s quite unpredictable. Also, some balloons are somewhat fragile. Some can take a lot of force to pop, and others require only the lightest touch to pop. Rupture of cysts can be unpredictable, tender, and painful. Rupture often occurs with sudden force or attempts to squeeze or evacuate the cyst.

What if my cyst ruptures? A ruptured cyst is usually red, swollen, and very painful. If the cyst is already open to the skin, sometimes it will drain on its own, or sometimes we drain them in the office. If the ruptured cyst is not draining or open to the skin, Dr. Rosenberger often will inject the cyst with a small amount of injectable steroid and allow the cyst to resorb on its own. This way is preferable to most patients as it provides pain relief and a scar-free approach. However, it can take months for the cyst to resorb.

I hope this answers your most common questions about cysts. If you want or need to have a cyst evaluated, we are happy to see you in the office.

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