Epidermoid and pilar cysts, commonly known as “sebaceous cysts,” can sound concerning at first, but rest assured that they’re generally harmless. While they may raise questions about their causes or whether treatment is necessary, these growths are more of an inconvenience than a serious health issue. By understanding what they are, why they occur, and how they’re treated, you can make informed decisions and approach them with confidence. Let’s explore these common skin conditions together.
What Are Epidermoid and Pilar Cysts?
Cysts are small sacs filled with fluid or semi-fluid material, and they can develop almost anywhere on the body. Epidermoid and pilar cysts are two of the most common types found just beneath the skin’s surface. While the term “sebaceous cyst” is inaccurate because these cysts don’t originate in sebaceous glands, many doctors still use this term.
Epidermoid or epidermal cysts form from epidermal cells, which are cells on the top layer of the skin. They are also called inclusion cysts or keratin cysts. On the other hand, pilar or trichilemmal cyst originates from cells at the base of hair follicles.
Despite their different origins, these cysts look and feel similar. Both epidermoid and pilar cysts are also filled with a keratin-rich, cottage cheese-like substance produced by skin cells, and distinguishing between them requires a microscopic examination of their cells.
What Causes Epidermoid and Pilar Cysts?
The exact cause of these cysts often remains unclear. In most cases, they develop when cells that should shed naturally instead become trapped beneath the skin and continue to grow. These cells form a sac that produces keratin, which builds up inside and creates the characteristic lump. Hygiene or exfoliation habits don’t influence their development, so there’s no way to prevent them entirely.
Are Epidermoid and Pilar Cysts Hereditary?
For pilar cysts on the scalp, a hereditary link has been identified in some families, though this is rare. Epidermoid cysts are not hereditary and typically occur spontaneously without a clear cause. However, a genetic condition may be involved if multiple cysts develop in unusual locations, such as on the fingers or toes.
Are These Cysts Painful?
In general, epidermoid and pilar cysts aren’t painful unless they become infected, inflamed, or irritated. Many people choose to leave them untreated, especially if they’re small and not causing any discomfort. However, there are three common reasons why someone might seek treatment for an epidermoid cyst or pilar cyst:
- Cosmetic Concerns: A cyst on the face or other visible areas may affect self-confidence.
- Irritation: Cysts on the scalp, for instance, can be easily irritated during hair combing or styling.
- Recurring Infections: If a cyst frequently becomes infected or inflamed, removal can prevent further issues.
Symptoms and Signs of Epidermoid and Pilar Cysts
Both epidermoid and pilar cysts are smooth, round lumps beneath the skin that vary in size. Initially, they’re often small, usually pea-sized, but over time, they can grow to several centimetres in diameter. Although usually painless and benign, they can occasionally present additional symptoms:
Infection: Cysts can become red, swollen, and painful if infected, often requiring antibiotics.
Leakage: If punctured, they might release keratin material, resembling a thick paste.
Horn Formation: A small, horn-like growth can appear on the surface of the skin over the cyst.
Discomfort: They may cause irritation if located in sensitive areas, such as near nails or genitals.
While they typically cause no harm, any noticeable growth should be evaluated by a doctor to rule out other conditions.
Who Is Affected by These Cysts?
Epidermoid cysts can develop in anyone, although they are more common in young and middle-aged adults. They often appear on areas like the face, neck, chest, and upper back.
On the other hand, pilar cysts are more common in middle-aged women and are usually found on the scalp. It’s common for multiple pilar cysts to form simultaneously in this area.
Pilar cysts are more likely to develop if there is a family history. In some rare cases, epidermoid cysts may occur as part of a genetic disorder, especially if they appear in unusual locations like the fingers or toes.
How Are Epidermoid Cysts Diagnosed?
Diagnosing epidermoid cysts is usually straightforward and begins with a physical examination. Doctors can often identify these cysts by their appearance. They are smooth, round lumps beneath the skin that are typically painless unless infected.
During consultation, your doctor may ask questions about any changes you’ve noticed in the cyst, such as whether it has grown, become painful, or shown signs of infection like redness or swelling. If the diagnosis isn’t immediately clear, they may recommend further steps to get a closer look. For example, an ultrasound might be used to check the cyst’s structure and confirm what’s going on beneath the surface.
Occasionally, epidermoid cysts may resemble other growths such as lipomas or, in rare cases, tumours. This is why, in some cases, a small sample of the cyst (biopsy) may be sent to a laboratory to confirm the diagnosis or rule out other conditions.
Removal of Epidermoid and Pilar Cysts
Epidermoid and pilar cysts are a common occurrence, and while they’re generally harmless, they can be a source of concern or discomfort for some. For some, the location of the cyst may make it an aesthetic concern, especially when it appears on visible areas like the face or neck. Some individuals come to us for Gold Coast sebaceous cyst removal because of repeated infections or inflammation.
Fortunately, the removal of an epidermoid cyst or pilar cyst is a straightforward procedure that can be done under local anaesthetic. During the procedure, a small incision is made, and the cyst is carefully removed. The sac must be fully extracted to reduce the risk of recurrence.
After the pilar or epidermoid cyst treatment, the wound is stitched, leaving a small scar. For many, this trade-off is worth it, especially if the cyst is causing physical or emotional discomfort. That said, some may find themselves wishing they had kept the cyst, particularly if the scar becomes more noticeable than expected.
