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Epidermoid cyst

The Toronto Dermatology Centre is one of the best places in Canada to manage your skin lesions such as epidermoid cysts or sebaceous cysts. Our staff of outstanding Toronto dermatologists offer both a comprehensive assessment and diagnosis of your skin, and also discuss all the treatment options.

Epidermoid cysts form as a result of the growth of epidermal cells within a focal area of the dermis. Most epidermoid cysts grow slowly and do not cause any problems. However, because of trauma or other factors, cysts can become inflamed and less commonly infected which results in redness, tenderness and pain. Epidermoid cysts can occur at any age, but are more common in young adulthood, and appear to be more common in men. Epidermoid cysts are also commonly referred to as “sebaceous cysts.”

Patients present to clinic for a variety of reasons, including the cosmetic appearance of a lump on their body, the odiferous cheese/curd-like material which can be extruded, or because of discomfort associated with inflammation or infection. Most often the “infected cyst,” is really just inflamed due to rupture of the cyst contents into the dermis.

Clinically, the lesions appear as firm, round, flesh-colored nodules of various size, often with a central punctum. The most commonly affected areas are the head and neck and trunk. Cysts have also been reported on oral, genital (e.g. after female circumcision), and ocular mucosae, and pretty much anywhere on the body.

The cause is not quite clear, but some factors which may play a role include occlusion of the pilosebaceous unit, HPV infection, or traumatic implantation of epidermal elements. The diagnosis of epidermoid cysts is usually made clinically.

Epidermoid cysts require treatment only if symptomatic or if the patient wants it removed for cosmetic purposes. A tender, inflamed, uninfected cyst often benefits from intralesional triamcinolone acetonide (Kenalog®) injection of 10-40mg/ml. For cysts presumed or proven to be infected, incision and drainage is recommended following by oral anti-staphylococcal antibiotics.

Epidermoid cysts are excised using a classic large incision, mini incision, or trephination with a punch biopsy device. Incising and draining is a quick procedure, but has high recurrence risk since the entire cyst wall contents are unlikely to be evacuated. Mini-incisions or punch biopsy trephination is more popular now as recurrence rates are relatively low (less than 10%) and the scar size is minimized. Cyst removal in Toronto Dermatology Centre is a common, effective, and safe procedure.

Here is a selection of medical scientific articles by our expert dermatologists Dr. Benjamin Barankin and Dr. Anatoli Freiman as they pertain to epidermoid cysts:

What’s Your Diagnosis? – Epidermoid cyst
Clinical case blog – Epidermoid cyst

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