Skin Cyst

What Are Skin Cysts?

A skin cyst is a small, round bump that forms underneath the skin's surface. These cysts are small sacs filled with keratin (a protein found in skin cells), fluid, or other material. They range in size from smaller than a pea to several centimeters across. Skin cysts are most often found on the face, neck, torso, or genital areas.

Skin cysts form when the skin's natural shedding process goes wrong. Normally, dead skin cells come off and are replaced by new cells. However, sometimes these cells move deeper into the skin instead, forming the wall of the cyst and filling it with keratin. Over time, these cysts can grow larger and may get inflamed or infected.

While skin cysts can be annoying, they are usually harmless. However, an inflamed or infected cyst can be painful. The area may be red, tender, and warm to the touch. The cyst may leak pus or smell bad. If you notice these signs of infection, it's important to see your healthcare provider for treatment.

Common Types of Skin Cysts

There are several types of skin cysts, each with its own characteristics:

• Epidermoid cysts are the most common type. They often grow on the face, neck, chest, upper back, or groin area. These cysts may have a small blackhead-like opening in the center. Epidermoid cysts are formed from cells in the top layer of skin (epidermis).
• Pilar cysts, also known as trichilemmal cysts, develop from hair follicles. They most often appear on the scalp. Pilar cysts tend to be firmer than epidermoid cysts and may be genetic. 24
• Milia are tiny epidermoid cysts that often appear on the face, especially around the eyes and cheeks. These small, white bumps are very common in newborns but can affect people of all ages.
• Pilonidal cysts develop in the crease of the buttocks near the tailbone. They are often caused by ingrown hairs and are more common in men than women. Pilonidal cysts can be quite painful, especially if infected. 2,3
• Dermoid cysts are present from birth. They grow when skin and skin structures become trapped during fetal development. These cysts may contain hair, sweat glands, and other tissues. Dermoid cysts are most often found on the head, neck, or face. 8

Some rare types of skin cysts include steatocystoma multiplex (multiple cysts filled with sebum, the oily substance produced by skin glands) and arachnoid cysts (sacs filled with cerebrospinal fluid that develop between the brain and spinal cord membranes). 8,9

Causes and Risk Factors of Skin Cysts

Skin cysts can develop for a number of reasons:

• Trauma or injury to the skin: A cut, puncture, or surgical incision can cause skin cells to move deeper into the skin and form a cyst rather than sloughing off normally. 5
• Blocked hair follicles or skin glands: When a hair follicle or sebaceous (oil) gland becomes clogged with keratin, dead skin cells, or oil, a cyst may develop. 5
• Genetic factors: Certain inherited syndromes, such as Gardner syndrome or basal cell nevus syndrome, can cause skin cyst development. 10 Some types of cysts, like pilar cysts, tend to run in families.
• Sun damage: UV radiation can thicken the skin's outer layer and make it harder for dead skin to shed normally.
• Hormonal changes: Hormonal changes such as those during puberty or pregnancy, can stimulate the skin’s oil production and cause cysts to develop.
• Certain medications: Some medications such as corticosteroids, testosterone, or lithium, may increase the risk of developing skin cysts as a side effect. 7

While anyone can develop a skin cyst, some factors may increase your risk:

• Age: Epidermoid cysts are most common in adults, typically appearing in the third or fourth decade of life. 4
• Sex: Some types of cysts, like pilonidal cysts, are more common in men than women. 2,3
• Personal or family history of cysts: Some cysts, especially pilar cysts, may have a genetic component. 11
• Acne or other inflammatory skin conditions: These can cause follicle blockage and rupture.
• Excessive sun exposure: High sun exposure without adequate protection.

It's important to note that in many cases, skin cysts develop for no apparent reason. Even without any known risk factors, skin cysts are common.

Symptoms and Diagnosis of Skin Cysts

The main symptom of a skin cyst is a noticeable lump underneath the skin's surface. These lumps are usually:

• Round, dome-shaped, or movable under the skin
• Flesh-colored, white, or yellow
• Painless or only mildly tender unless inflamed or infected
• Slow-growing, often taking months or years to reach a noticeable size

Some specific types of cysts may have other distinguishing features. For example, an epidermoid cyst may have a small, round opening in the center that looks like a blackhead. A pilonidal cyst may be painful, drain pus, and cause redness and swelling in the area between the buttocks. 2,3

If a cyst becomes inflamed or infected, you may notice:

• Redness and swelling around the cyst
• Pain, tenderness, or warmth when touched
• Pus or foul-smelling drainage from the cyst
• Rapid increase in size over a few days

If you notice any signs of infection, it's important to see your healthcare provider promptly. Infected cysts often need medical treatment with antibiotics or drainage to prevent complications.

Diagnosing Skin Cysts

In most cases, your healthcare provider can diagnose a skin cyst with a simple physical exam and review of your medical history. They will ask about your symptoms, how long you've noticed the lump, and any possible causes (like an injury to the area).

During the exam, your provider will look at the size, shape, location, and appearance of the cyst. They may also feel the area to check for tenderness, firmness, and if the lump moves. This exam can help rule out other possible causes of skin lumps, like lipomas (fatty tumors) or swollen lymph nodes.

Your provider may recommend additional tests to confirm the diagnosis or rule out more serious conditions:

• Skin biopsy: removing a small sample of the cyst wall for laboratory analysis. This can confirm the type of cyst and rule out skin cancers that may look like cysts. 6
• Imaging tests: like ultrasound, CT scan, or MRI. These may be used to see the size and extent of a very large or deep cyst, or to check for cysts in internal organs like the ovaries or breasts.
• Culture and sensitivity: of pus from an infected cyst. This lab test can identify the bacteria causing the infection and help your provider choose antibiotic treatment.

It's important to have any new or changing skin lumps checked by a healthcare provider. While most epidermoid cysts are harmless, some more serious conditions (like slow-growing skin cancers) can look like cysts. 6 An accurate diagnosis will help you get the right treatments.

Treatment and Prevention of Skin Cysts

Many skin cysts don't require treatment if they are small and not causing any symptoms. However, if a cyst is large, painful, infected, or in a bothersome location, treatment can help:

• Drainage: In some cases, your healthcare provider can drain a cyst by making a small cut and squeezing out the contents. This may be done in the office under local anesthesia. However, cysts often come back after simple drainage if the cyst wall is not also removed.
• Injection: Injecting a cyst with a corticosteroid medication can help reduce inflammation and may cause the cyst to shrink or disappear. This treatment is most effective for small, newly-formed cysts.
• Surgical excision: The most permanent treatment for a skin cyst is to surgically remove the entire cyst, including the cyst wall. This is typically done in the office under local anesthesia. An excision may need a few stitches and will leave a small scar. However, removing the whole cyst prevents it from growing back. 1
• Antibiotics: If a cyst becomes infected, your provider may prescribe oral or topical antibiotics to clear the infection before considering removal.
• Home care: Applying a warm, moist cloth to a cyst for 20-30 minutes a few times daily can help soothe discomfort and encourage drainage in some cases. However, it's important not to squeeze or "pop" a cyst at home, as this can cause infection.

The right treatment approach depends on the type, size, location, and symptoms of the cyst, as well as your health and preferences. Your provider can recommend the best option for your case.

Prevention

While not all skin cysts can be prevented, some self-care measures may help reduce your risk:

• Keep skin clean and moisturized to prevent clogged pores and follicles. Use gentle cleansing and non-comedogenic moisturizers.
• Protect skin from excessive sun exposure with a broad-spectrum sunscreen, protective clothing, and shade.
• Don't squeeze or pick at blemishes, as bacteria can get in and cause follicle rupture and cyst formation.
• Avoid excessive friction or pressure on skin, especially in areas prone to cysts. Loose, breathable clothing can help.
• Manage chronic skin conditions like acne with over-the-counter or prescription treatments as recommended by your healthcare provider.
• Maintain a healthy lifestyle with a balanced diet, adequate hydration, regular exercise, and stress management to support overall skin health.

If you have a personal or family history of skin cysts, being proactive about skin care and monitoring for changes can help you treat cysts early if they do develop.

Conclusion

Skin cysts are a common condition that can affect people of all ages and skin types. While they are usually harmless, they can sometimes cause discomfort, embarrassment, or other complications if left untreated.

If you notice any new or changing lumps on your skin, schedule an appointment with your dermatologist or a healthcare provider. They can evaluate and treat the lump. With proper care and attention, most skin cysts can be effectively managed, allowing you to maintain healthy, comfortable skin.

Citations:

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