Sebaceous cysts and similar types that we will discuss in this article are quite common, and while they may be a cosmetic concern or simply an annoyance, if they do not become infected or otherwise become a problem, they do not usually need to be treated. The vast majority of these types of cysts are benign, although in a small percentage of cases they can very rarely lead to skin cancers. Since they are so common, let’s see if we can gain a better understanding of why and how they form, and what our options are for dealing with them.
What Are Sebaceous Cysts?
Sebaceous cysts are closed sacs under the epidermis (outermost layer of skin) that are filled with a protein produced by the skin called keratin. They are typically associated with swollen hair follicles, and true sebaceous cysts are relatively rare. Much more common are similar cysts that are often incorrectly referred to as sebaceous cysts. The most common types are epidermoid cysts and pilar cysts. Epidermoid cysts are by far the most common.
Perhaps the best way to approach a study of this family of cysts is to take a look at each different type, starting with the most common, epidermoid cysts.
Epidermoid cysts are generally round sacs just underneath the epidermis that can range in diameter from ¼ inch to about 2 inches. Most of them are often described as “pea-sized.” One of their distinguishing characteristics is that they are typically “free-moving.” They can be found anywhere on the body, but are most often located on the face, neck, trunk, or sometimes near the fingernails. They are usually white or yellow in appearance, but will often take on the pigmentation of darker skinned people.
These types of cysts are often filled with keratin that appears as a thick “cheesy” substance that is white or yellow in color. Some people describe it as “toothpaste-like” in both consistency and appearance. Cysts form when keratin cells, which normally are found on the surface of the skin, begin to reproduce deeper in the skin where hair follicles normally grow. As the keratin accumulates in the cyst or “sac,” it becomes soggy and semi-liquid in consistency. The cysts normally have a central point or opening that corresponds with the hole where a hair shaft pushes through the skin. Most epidermoid cysts can be squeezed and produce keratin on the surface of the skin, but it is not recommended that one does that, as this can increase the likelihood of infection. The keratin may have a strong, foul odor associated with it, which becomes much worse if infection is present.
A subtype of epidermoid cysts appears as small whiteheads on the face that never project onto the surface of the skin. These are known as milia, and are most common in older women who have a history of consistent usage of oily cosmetics and skin care products, or in older men and women who have sun damage in the facial area.
Epidermoid cysts are not themselves inherited, but certain conditions that are hereditary, such as Gardner’s Syndrome or Basal Cell Nevus Syndrome, are characterized by the development of epidermoid cysts.
Sebaceous cysts are more rare than epidermoid cysts, and are distinguished by their formation at the site of swollen or infected hair follicles. The name sebaceous is derived from a gland found at the root of hair follicles that emits sebaceous oil to coat, nourish, and protect skin and hair shafts. They are very similar to epidermoid cysts in both appearance and behavior, and all these types of cysts used to be incorrectly classified as sebaceous cysts. They are more commonly found at sites where a higher concentration of hair follicles exists, such as the face, groin, genitals, and underarms.
Pilar cysts are the rarest form in this family of cysts, and behave and appear similar to their cousins. One difference is that the material that accumulates in pilar cysts is not composed of cells that normally appear on the surface, but just the opposite. Pilar cysts are filled with material that normally is found at the base of hair follicles. Pilar cysts almost always form on the scalp, but they can rarely be found on other parts of the body. The most common victims of these cysts are middle-aged women. Another unique characteristic of pilar cysts is that unlike other types of cysts, they run in families and there seems to be a pattern of heredity in their formation, with the absence of any related diseases or syndromes, as is the case with epidermoid cysts.
What Causes These Cysts to Form?
The epidermis, or outer layer of skin, is normally composed of thin, protective skin cells that are constantly being shed and replenished. For reasons that are not fully understood as of yet, cysts will form when these outermost skin cells abnormally begin to multiply deeper in the skin at the site of hair follicles and their corresponding sebaceous glands. We do know that certain factors increase the risk of this happening. Some of the most common causes are:
- Acne: If you have a history of acne or other similar skin disorders, the irritation can make it more likely that you will develop cysts. Acne often causes sebaceous glands to easily rupture. The longer the acne has been present, the greater the cumulative effect, and the greater the risk for cysts.
- Gender: The most common type of cysts, epidermoid cysts, are found twice as often in men as in women.
- Age: Most cysts form in folks in their 30’s or 40’s.
- Damaged hair follicles: This often occurs due to skin abrasions or other wounds. Scarring can cause hair follicles to become blocked by skin cells, and increase the likelihood of cysts forming.
- Trauma: If your skin is crushed or broken from an injury, such as hitting your finger with a hammer or catching it in a car door, the risk for cysts increases.
- Birth Defects: Sometimes cells will become trapped in wrong places while a fetus is developing. For example, future skin or hair cells may form in other organs and later cause cysts to form soon after birth, or even years in the future.
Can Any Complications Occur From Cysts?
Yes they can. While the vast majority of epidermoid, sebaceous, and pilar cysts are harmless, on some occasions they can be a more serious health concern. The most common potential complications are:
- Skin cancers: A very small percentage of cysts can progress into a malignant state. What you should watch out for is any unusual behavior of the cysts. For example, normal cysts are freely moving. If a cyst is solid and immovable, it may indicate a more serious problem. Any inflamed or infected cyst that does not easily heal over an extended period of time is also of concern.
- Infection: An infection, usually bacterial, may occur in some cysts. Generally infections are not serious, but the potential always exists of a systemic infection that spreads to other organs via the circulatory system.
- Ruptured cysts: If a cyst ruptures, the risk of infection is much greater. Sometimes the infection will be internal and can form a pocket of pus called an abscess. Other times it may develop into a boil that can be quite painful.
- Pain and discomfort: Depending on where a cyst forms and the degree to which it is inflamed, it may be quite painful. One of the most painful locations is typically in the genital area of both men and women. Cysts in this area can lead to painful urination and intercourse.
What Treatments Are Available for Cysts?
Medications are generally not used to treat cysts, with the exception of antibiotics in cases of infection. The majority of epidermoid, sebaceous, and pilar cysts are harmless and symptom free and are usually best left alone. The exception to this is a cyst that has formed in an area that is very sensitive or where the cysts have the capability of being constantly aggravated. An example would be a pilar cyst that is irritated by brushing or combing the hair. The typical options for cyst treatment include:
- Corticosteroids: These drugs can be injected into a cyst to help reduce inflammation, but I do not recommend the use of steroids. The side effects are many, and while the patient may experience short-term relief, steroids weaken the immune system, and the long-term consequences are not worth it.
- Incision: This option involves making a small cut into the cyst, and draining out the keratin and/or any infected material. This may be done by a health care practitioner, or self-administered. Just be sure to keep the environment sterile and clean. The downside of incision is that most times the cyst will reappear.
- Excision: There are two options for excision of a cyst: minimal or total. Minimal excision involves removal of the cyst by means of a small incision through which the wall of the cyst is taken out. Scarring is minimized, but the cyst may reoccur. Total excision of the cyst involves a more comprehensive procedure, but the cyst is not likely to return. In sensitive places that are of cosmetic concern, such as on the face, minimal excision is the favored option.
- Laser surgery: Some cysts can be effectively removed through the use of a laser.
Can Cysts Be Prevented?
Some cysts seem to form for no discernable reason. However, as with most wellness issues, lifestyle and wise choices as we travel through life can minimize the risk for cysts. Eliminating the use of oil-based make up and skin care products will greatly help the health of the facial skin, and avoid cysts and other potential skin disorders. Protection from the damaging effects of the sun is also critical. Eating a diet that is packed with natural whole foods and that avoids high-fat, processed junk will greatly affect your overall health and decrease the risk of many kinds of diseases and disorders, cysts included. Consuming lots of fresh fruits and vegetables will also help to keep the immune system strong, and will discourage the growth of cysts and decrease the likelihood of complications such as infection should they occur.
Cysts are mainly an annoyance or cosmetic concern in most cases. If you do develop a cyst, most of the time it will heal itself in time, or may remain indefinitely and best be left alone. Keep an eye out for any changes in the behavior of cysts, and don’t fret about them. Do your best to live a healthy lifestyle that will accomplish the goal of complete wellness that we all should be seeking. It’s a lifelong journey that will pay off in countless ways.