Cysts and Infections

The skin and the underlying subcutaneous layer are home to various cysts. They may appear to be right on the skin, or sometimes, deep under the skin. Most of the time they are inconsequential, but when they “act up” and become inflamed or infected, you will be forced to see a physician or go to the E.R., significantly impacting your life. Therefore, it is important that you pay attention to these cysts. When they become irritating, grow in size or the least bit inflamed, you should have them be removed immediately. If they become infected, they often need an incision and drainage (“I & D”), which is a very unpleasant, painful experience in the emergency setting.

Sebaceous Cyst or Epidermal Cyst

These cysts vary in size from very small ( < 1 cm or ½ inch) to very large (> 4-5 cm or 2 inches). They appear primarily on the face, back, lower neck or base of the ears, or anywhere else in the body, even on the labia. They maybe associated with a “blackhead” which is a visible keratin-filled orifice communicating through the skin. Removal of the cyst wall and the cyst content is the definitive treatment, most easily done when sterile and uninflamed. When they become inflamed and infected like a “boil”, they require a much more complex procedure and prolonged recovery. It is best to avoid this complication if at all possible. Therefore, if you have this condition, you should inquire about it with a physician or a dermatologist. These can get infected at the most inconvenient time in your life when you can least afford the time to deal with them.

Pilar Cyst

These cysts are similar to the epidermal cysts, except that they occur primarily on the scalp, and they are often multiple and very large in size. Even when sterile, they cause discomfort especially when brushing hair. When they become inflamed and infected, same rules apply as the epidermal cysts. It is much better to have these removed when they are small and uninflamed.

Abscess, Boils, Furuncle and Carbuncle

Abscesses on the skin and in the subcutaneous layer vary in size, acuity, and tenderness. They are red, fluctulent, tense, and exquisitely painful. They are associated with many causes, including infection of the hair follicle or epidermal or sebaceous cysts. When abscesses occur, they must be treated with incision and drainage. First, the affected area is numbed with a local anesthetic injected with a needle. This can be very painful in and of itself. Then the overlying skin and inflamed tissue must be incised and the pus from the abscess cavity drained. The resulting wound must be packed with a moist packing material, to be changed at regular intervals (e.g. once a day) until the abscess cavity closes from inside out. This process can take many days, if not weeks depending on the size. If possible, it is best to remove the cyst wall at the initial incision. If not possible, then there will always be a risk of recurrent infection, therefore a definitive excision of the cyst at a later date is recommended. Because these are such onerous treatment steps required to treat the infectious complication of an otherwise normal appearing cyst, you may do best to inquire about your cyst to a physician when it appears to be indeed a “no big deal.”

Hidradenitis Suppurativa

Hidradenitis is an unfortunate chronic condition arising from inflammation and infection of a certain “oil-producing” cells of the skin called the apocrine glands. They occur primarily where these glands are located, namely in the axilla (underarms), groins, mammary (breast) folds, and less commonly, the genital areas. The infection involves the surrounding subcutaneous fat and leaks pustular drainage through sinus tracts. The treatment is initially with antibiotics, however, eventually often requires incision and drainage, followed by a period of wound packing. Recurrence rate is high. Extensive excision of all affected tissue in the underarms or the groins would be the definiive treatment, however, such a decision must be thoroughly discussed and carefully planned with a surgeon regarding the benefits and the risks of such a procedure.

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