Sebaceous cysts

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^T^^B^D: Epithelium-lined, keratinous, debris-filled cyst arising from a blocked hair follicle. More correctly known as epidermal cyst.

Occlusion of the pilosebaceous gland, traumatic insertion of epidermal elem-^^ ents into the dermis and embryonic remnants (see Pathology).

^^ |a/R: More frequent in Gardner's syndrome.

Extremely common, any age.

Nontender slow-growing skin swelling, often multiple.

Common on hair-bearing areas of the body, especially face, scalp, trunk or scrotum.

^^ May become red, hot and tender if superimposed inflammation or infection.

OE: Smooth tethered lump with overlying skin punctum.

May express granular creamy material with an unpleasant smell.

^^ ^iP: Despite their name, these cysts are not derived from sebaceous glands. Sebaceous cysts result from the cystic proliferation of epidermal cells within the dermis. The source of this epidermis is often the infundibulum of the hair follicle. Inflammation is usually a foreign body, granulomatous reaction to material contained within the cysts.

I: None usually required.

Skin biopsy or FNA may rarely be necessary to rule out other differentials.

M: Conservative: May be left alone if not causing the patient distress.

Surgical: Excision of cyst can be carried out under local anaesthesia. Care must be taken to ensure complete removal or the cyst is liable to recur. If an abscess develops in association, it should be drained.

Medical: If there is infection, antibiotics may be given; however, definitive treatment involves excision once acute inflammation has settled.

_C Infection, abscess formation. Recurrence if excision is incomplete. Occasionally, may ulcerate and have the appearance of a skin malignancy (Cock's peculiar tumour). A sebaceous horn may develop if the discharging contents dry out and form a horn-shaped protrusion.

_P: Excellent, most do not require treatment and excision is usually curative.

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