How to Treat Sebaceous Cysts: A Doctor's Guide to Safe Removal

monami yoneda
Aug 18
15 min read

Learn about sebaceous cysts and when to seek professional medical care. This guide provides educational information about cysts and emphasizes the importance of professional medical evaluation like excision for permanent, safe removal by a doctor.

Understanding What a Sebaceous Cyst Is

A cyst is a closed, sac-like pocket of tissue that contains fluid, air, or other substances. While many people use the term "sebaceous cyst" to describe any small lump under the skin, it's important to understand that While the term 'sebaceous cyst' is commonly used, most skin cysts are actually epidermoid or pilar cysts. A healthcare professional can provide accurate diagnosis. These growths are typically benign (noncancerous) and usually develop slowly over time.

The Difference Between Sebaceous, Epidermoid, and Pilar Cysts

Understanding the correct terminology helps in discussing your condition with a healthcare provider. Although they look similar, these cysts originate from different parts of the skin.

Epidermoid Cysts: These are the most common type. They form when surface skin cells (epidermal cells) move deeper into the skin and multiply, forming a sac. The sac fills with keratin, a soft, yellowish, cheese-like protein that makes up your skin and nails. They can appear anywhere but are most common on the face, neck, and trunk.
Pilar Cysts (Trichilemmal Cysts): These cysts grow from the cells of a hair follicle, most often on the scalp. The wall of a pilar cyst is thicker than that of an epidermoid cyst, making it easier for a doctor to remove the entire sac intact. The contents are also primarily keratin.
True Sebaceous Cysts: These are far less common. They arise from sebaceous glands, which secrete the oily substance (sebum) that lubricates hair and skin. When these glands get blocked, a cyst containing sebum can form. They are often associated with genetic conditions like Gardner's syndrome.

What Causes These Cysts to Form

The underlying cause of a cyst is typically a blockage or disruption of a skin structure. The specific cause depends on the type of cyst.

Epidermoid cysts often develop after damage to a hair follicle or the top layer of skin (epidermis). This can be caused by a skin injury, a surgical wound, or a condition like acne. The damaged surface cells get trapped underneath and begin to multiply, forming the cyst wall and filling it with keratin.
Pilar cysts are primarily hereditary. They form from the outer root sheath of a hair follicle. The tendency to develop them often runs in families.
True sebaceous cysts are caused by blocked or damaged sebaceous glands.

Common Misconceptions About Cysts

Misinformation about skin cysts can lead to improper care and unnecessary worry. Here are some common myths debunked:

Myth: Cysts are contagious. Fact: Cysts are not contagious. They are self-contained growths and cannot be spread from person to person through contact.
Myth: Cysts are a form of cancer. Fact: Most epidermoid and pilar cysts are benign. While skin cancer can sometimes appear as a cyst-like bump, malignant transformation of typical cysts is uncommon. Proper medical evaluation is important for accurate diagnosis.
Myth: Cysts are just large pimples. Fact: Pimples are caused by clogged pores with bacteria and inflammation and are typically superficial. Cysts are deeper, sac-like structures that contain keratin and are much more persistent.
Myth: All cysts will go away on their own. Fact: While some small cysts may resolve, most are persistent. Without complete removal of the cyst sac, they will often remain or recur, even if they are drained.

How to Identify a Sebaceous Cyst

Correctly identifying a sebaceous cyst is the first step toward proper management. While a definitive diagnosis must come from a healthcare professional, understanding the typical signs can help you determine if what you have is likely a cyst. These slow-growing bumps originate from your skin and are generally harmless.

Key Symptoms and Physical Characteristics

Sebaceous cysts, more accurately known as epidermoid or pilar cysts, have several distinct features:

Shape and Size: They are typically small, round, dome-shaped bumps that are visible on the skin's surface. Their size can range from a few millimeters to several centimeters in diameter.
Texture and Mobility: The cyst usually feels smooth to the touch and can be moved slightly under the skin, indicating it is not attached to deeper tissues.
Central Pore (Punctum): Many epidermoid cysts have a tiny, dark opening on the surface known as a central punctum. This is the blocked opening of the hair follicle from which the cyst formed.
Painless Nature: A non-inflamed cyst is usually painless. Pain, tenderness, and redness are signs of inflammation or infection.
Contents: If the cyst were to rupture, it would release a thick, yellow, cheese-like substance called keratin, which often has a foul odor.

Common Locations on the Body

Because these cysts arise from hair follicles or skin glands, they can appear almost anywhere on the body. However, they are most frequently found in areas with a higher concentration of sebaceous glands, including:

Scalp (these are typically pilar cysts)
Face and neck
Back and shoulders
Chest
Genital area

They are less common on the palms of the hands and soles of the feet, as these areas lack hair follicles.

Differentiating a Cyst from Other Skin Bumps

Several other skin conditions can resemble a cyst. Knowing the differences can help you understand what you might be dealing with.

Lipoma: A lipoma is a benign tumor made of fat tissue. Unlike a cyst, a lipoma feels soft and rubbery, is located deeper under the skin, and does not have a central punctum.
Boil (Furuncle): A boil is a painful, pus-filled infection of a single hair follicle. It develops quickly, is very tender and red, and typically comes to a head with a visible white or yellow center of pus. Cysts are generally slow-growing and painless unless they become infected.
Acne Nodule or Cystic Acne: These are severe forms of acne that form deep within the skin. They are often painful, inflamed, and can occur in clusters, unlike a solitary sebaceous cyst. They are part of a broader pattern of acne.
Abscess: An abscess is a larger, painful collection of pus under the skin caused by a bacterial infection. It is typically warm to the touch, swollen, and requires immediate medical attention, whereas a cyst is a self-contained sac of keratin that only becomes an abscess if severely infected.

Why You Should Never Squeeze or Pop a Cyst at Home

The temptation to squeeze or pop a cyst can be overwhelming, but this is one of the most common mistakes people make. Unlike a pimple, a cyst is a self-contained sac beneath the skin. Attempting to pop it at home is a risky DIY procedure that can lead to significant complications, turning a minor cosmetic issue into a serious medical problem.

The High Risk of Infection and Inflammation

When you try to squeeze a cyst, you create an open wound by breaking the skin's protective barrier. This allows bacteria from your hands and the skin's surface to enter the cyst cavity, leading to a painful infection. Furthermore, the pressure can cause the cyst wall to rupture underneath the skin, releasing its contents—a thick, cheese-like substance called keratin—into the surrounding tissue. Your body recognizes this material as foreign and launches a strong inflammatory response. This can quickly transform a calm, painless lump into a swollen, red, and tender abscess that often requires medical drainage and antibiotics.

The Likelihood of Scarring and Recurrence

Aggressive squeezing traumatizes the skin far more than a precise surgical incision. This damage and the subsequent inflammation significantly increase your chances of developing a permanent and unsightly scar. More importantly, popping a cyst does not solve the underlying problem. You may force out some of the contents, but the cyst sac, or wall, remains behind. As long as this sac exists, it will continue to produce and collect keratin, making it likely that the cyst will eventually return. Often, a recurring cyst comes back larger and more inflamed than it was originally. Surgical excision by a doctor may help reduce the likelihood of recurrence, though individual outcomes may vary.

When Popping Can Be Dangerous

In some cases, attempting to pop a cyst can be genuinely dangerous. Squeezing can push infected material deeper into your skin, potentially causing a widespread skin infection known as cellulitis. The location of the cyst also matters. Attempting to pop a cyst on the face, particularly within the "triangle of death" (the area from the bridge of the nose to the corners of the mouth), carries a small but serious risk of the infection spreading to the brain. Finally, what you believe is a simple cyst could be a more serious condition, such as a boil or, in rare instances, a form of skin cancer. Self-treating can delay a proper diagnosis and necessary medical care.

Safe At-Home Management for Minor Cysts

While professional medical treatment may help with cyst removal, you can manage small, non-painful cysts at home. These methods are aimed at encouraging natural drainage and preventing infection, not at removing the cyst sac itself. It is crucial to remember that you should never attempt to pop or lance a cyst on your own.

Using a Warm Compress to Promote Drainage

Applying gentle heat can be an effective first step for managing a minor cyst. A warm compress helps increase blood circulation to the area, which can encourage the cyst to break down and drain naturally. This process helps to thin the keratin or sebum trapped inside the cyst, making it easier for the body to reabsorb or expel it.

To use a warm compress correctly:

Soak a clean washcloth in warm water. The water should be comfortably warm, not hot enough to burn your skin.
Wring out the excess water and place the cloth directly over the cyst.
Hold the compress on the area for 10 to 15 minutes.
Repeat this process three to four times daily until the cyst shows signs of shrinking or draining.

If the cyst begins to drain, gently clean the area and cover it with a sterile bandage. Do not force the drainage by squeezing.

Keeping the Area Clean and Protected

Maintaining good hygiene is essential to prevent bacteria from entering the cyst, which could lead to a painful infection or abscess. A clean environment reduces the risk of complications, especially if the cyst drains.

Wash the skin over and around the cyst daily with a gentle, antibacterial soap and water.
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Pat the area dry with a clean towel. Avoid rubbing the cyst, as this can cause irritation and inflammation.
If the cyst is in an area that experiences friction from clothing, like under a waistband or bra strap, cover it with a loose, sterile bandage to protect it from irritation.

Monitoring for Signs of Infection

While managing a cyst at home, you must watch closely for any signs of infection. An infected cyst requires immediate medical attention and cannot be treated at home. Stop all at-home care and consult a doctor if you notice any of the following symptoms:

Significant increase in pain, tenderness, or swelling.
The skin over the cyst becomes red, or red streaks appear to be spreading from the area.
The area around the cyst feels warm to the touch.
The cyst begins to discharge thick, yellow, or green pus that has a foul odor.
You develop a fever or feel unwell.

These are clear indicators that the cyst has become infected or has formed an abscess, and professional medical intervention is necessary.

When to See a Doctor for Your Cyst

While many small, painless cysts can be monitored at home, certain signs and symptoms indicate that it’s time to seek professional medical advice. Attempting to treat a complicated cyst on your own can lead to further issues. A healthcare provider, such as a doctor, can ensure a correct diagnosis and provide safe, effective treatment.

Signs of an Infected or Ruptured Cyst

An infection is the most common complication of a sebaceous cyst and requires prompt medical attention. A cyst can become infected if bacteria enter through a small break in the skin or if it ruptures beneath the skin's surface, leading to a painful abscess.

Redness, Swelling, and Pain

These are the classic signs of inflammation and infection. If the skin over your cyst becomes red, tender, warm to the touch, and increasingly painful, it is likely infected. The cyst may also grow in size quickly due to the inflammatory response.

Foul-smelling Discharge

If the cyst bursts and releases a thick, yellow, or greenish pus with a foul odor, it is a clear sign of infection. Even the typical cheesy, white keratin that drains from a non-infected cyst can become mixed with pus. Any drainage accompanied by pain and redness should be evaluated by a doctor.

Cysts That Are Rapidly Growing or Causing Discomfort

A cyst that suddenly begins to grow quickly should always be examined by a healthcare professional. While this is often a sign of inflammation, a doctor will want to rule out other, more serious conditions. Additionally, if a cyst grows large enough to cause pain or pressure on surrounding nerves or tissues, or if it interferes with your daily activities, medical intervention can provide relief.

Cysts in Aesthetically or Functionally Sensitive Areas

The location of a cyst is a key factor in deciding whether to see a doctor. Cysts located in certain areas often warrant professional removal for cosmetic or functional reasons. This includes:

Face, neck, or scalp: Cysts in these highly visible areas can cause significant cosmetic concern.
Genitals or breasts: Any new lump in these areas requires a proper diagnosis to rule out other medical conditions.
Palms, soles, or near joints: A cyst in these locations can interfere with function, making it difficult to grip objects, walk comfortably, or move a joint freely.

Professional Medical Treatments Explained

While home care can manage symptoms, professional medical treatment may help ensure effective cyst removal with appropriate medical care. A doctor or general practitioner can offer several procedures depending on the cyst's size, location, and condition.

How a Doctor Diagnoses a Cyst

A diagnosis is typically straightforward. A healthcare provider will perform a physical examination, assessing the lump's size, shape, and mobility. They will ask about how long it has been there and if it has changed in size or become painful. In most cases, a visual inspection is enough. However, if the cyst has unusual features or there is uncertainty, your doctor may recommend further tests, such as an ultrasound to see the structure beneath the skin or a biopsy to rule out other conditions.

Incision and Drainage for Infected Cysts

If your cyst becomes inflamed, swollen, and painful, it is likely infected or ruptured. In this case, a doctor will perform an incision and drainage (I&D). The procedure involves:

Numbing the area with a local anesthetic.
Making a small cut (incision) into the top of the cyst.
Gently draining the pus and other contents.
Packing the cavity with sterile gauze to allow it to continue draining for a day or two.

This procedure may provide relief from pain but does not remove the cyst wall (sac). Because the sac remains, the cyst will likely recur in the future.

Complete Cyst Excision for Permanent Removal

To help reduce the likelihood of cyst recurrence, surgical removal of the entire cyst sac may be recommended. This procedure, known as an excision, is usually performed when the cyst is not inflamed or infected. It is a minor in-office surgery done under local anesthesia. There are two primary techniques.

Conventional Wide Excision

In a conventional excision, the surgeon makes an elliptical incision in the skin over and around the cyst. This approach provides a clear view, allowing the doctor to carefully dissect the cyst and its entire sac from the surrounding tissue. It may be effective at reducing the likelihood of recurrence but may result in a more noticeable linear scar. The incision is then closed with stitches.

Minimal Excision Technique

This method is designed to minimize scarring. The surgeon makes a very small incision, just a few millimeters long, directly over the cyst. The contents are expressed through the opening, and then the collapsed cyst sac is carefully pulled out through the same tiny hole. While this technique may result in a smaller scar, it requires significant skill to ensure the entire sac is removed.

Laser and Punch Biopsy Removal

In certain situations, other techniques may be used. This method may help minimize scarring, though results vary between individuals, making it useful for cysts on the face or other cosmetically sensitive areas. A punch biopsy tool may be used for tissue sampling and diagnosis of small lesions. The tissue removed is then typically sent to a lab for analysis.

What to Expect During and After Cyst Removal

Deciding to have a cyst professionally removed is generally considered an effective approach for cyst removal with lower recurrence rates. Understanding the procedure, from the first injection to the final stages of healing, can help ease any anxiety and set you up for a smooth recovery.

The Removal Procedure Step-by-Step

While the exact technique may vary, a standard cyst excision procedure in a doctor's office typically follows these steps:

Preparation: The skin over and around the cyst is thoroughly cleaned with an antiseptic solution, such as iodine or chlorhexidine, to minimize the risk of infection.
Numbing the Area: A local anesthetic, most commonly lidocaine, is injected into the skin surrounding the cyst. You may feel a brief sting or burning sensation from the injection, but the area will become completely numb within minutes. You will remain awake for the procedure but will not feel any pain.
The Incision: Once the area is numb, the doctor makes a small, precise incision over the cyst. The size and shape of the incision depend on the cyst's size and the chosen removal technique (e.g., a minimal excision uses a very small cut).
Cyst Removal: The primary goal is to remove the entire cyst, including the cyst wall or sac. The doctor will carefully dissect the sac from the surrounding tissue. Removing the sac intact is crucial for preventing the cyst from growing back. If the cyst is inflamed or ruptured, the contents may be drained first before the sac is removed.
Closing the Wound: After the cyst is removed, the incision is closed. This is usually done with one or more stitches (sutures). Depending on the location and the doctor's preference, these may be dissolvable stitches that disappear on their own or non-dissolvable ones that need to be removed at a follow-up appointment.
Dressing the Wound: A sterile ointment and a bandage are applied to the site to protect it and keep it clean.

Aftercare and the Healing Process

Proper aftercare is essential for a quick recovery and minimizing the risk of complications. Your doctor will provide specific instructions, which generally include:

Wound Care: You will likely be asked to keep the bandage clean and dry for the first 24 to 48 hours. Afterward, you may be instructed to gently clean the area daily with mild soap and water, pat it dry, and apply a fresh bandage.
Pain Management: Discomfort after the local anesthetic wears off is usually mild. Over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil) are typically sufficient to manage any soreness.
Activity Restrictions: Depending on the cyst's location, you may need to avoid strenuous activity, swimming, or movements that could stretch the skin and pull on the stitches for a week or two.
Suture Removal: If you received non-dissolvable stitches, you will need to return to the doctor's office to have them removed, usually 7 to 14 days after the procedure.

Managing Scars and Preventing Recurrence

Any procedure that cuts through the skin will leave a scar, but there are ways to manage its appearance and prevent the cyst from returning.

Scar Management: The final appearance of the scar may depend on various factors including the surgical technique, individual skin type, and healing process. To promote minimal scarring, follow all aftercare instructions carefully. Once the wound has fully closed, protect it from the sun with a high-SPF sunscreen to prevent discoloration. Your doctor may also recommend using silicone gel or sheets to help flatten and fade the scar over time.
Preventing Recurrence: Surgical removal of the cyst sac may be a factor in reducing the likelihood of cyst recurrence in the same location, though outcomes vary between individuals. If even a small piece of the sac wall is left behind, it can regenerate and fill with keratin again. This is why professional excision aims to remove the entire cyst wall. Your doctor can discuss the most appropriate treatment option for your specific case at home or in a clinic.

Can You Prevent Sebaceous Cysts

The development of cysts can be influenced by various factors. Maintaining good skincare practices may help support overall skin health. Understanding the factors at play is the first step in managing your skin's health.

Skincare Practices to Reduce Risk

Maintaining healthy skin can help prevent the blocked glands and hair follicles that often lead to cyst formation. While not a guaranteed solution, incorporating these practices into your routine can be beneficial.

Keep Skin Clean: Wash your face and body regularly with a gentle, non-comedogenic cleanser to remove excess oil, dead skin cells, and dirt that can clog pores and hair follicles.
Exfoliate Gently: Gentle cleansing and exfoliation may help maintain healthy skin. Consult a doctor for personalized skincare advice. Avoid harsh scrubs, as irritating or injuring the skin can sometimes trigger cyst formation.
Choice of skincare products should be individualized. A doctor can provide guidance on suitable products for your skin type, cosmetics, or sunscreens that can block sebaceous glands. Look for products labeled "oil-free" or "non-comedogenic."
Protect Skin from Injury: Since trauma to the skin can sometimes cause a cyst to form, try to protect areas prone to cysts from scrapes, cuts, or other injuries.

The Role of Genetics and Other Factors

For many individuals, the tendency to develop cysts is inherited. If your close family members have cysts, you are more likely to develop them as well. Beyond skincare, several uncontrollable factors influence their formation.

Genetic Predisposition: Your DNA plays a significant role. Certain genetic conditions, such as Gardner's syndrome, are directly linked to the formation of multiple cysts throughout the body.
Hormonal Changes: Fluctuations in hormones, particularly during puberty and adolescence, can increase oil production and the likelihood of developing cysts.
Age: Cysts are more common in adults than in children, although they can appear at any age.
Skin Trauma: A previous injury to the skin, such as a surgical incision, a scrape, or a condition like acne, can damage a hair follicle or gland, leading to the later development of a cyst in that location.

Summary

Dealing with a sebaceous cyst involves understanding what it is and knowing the right steps to take. These common lumps, more accurately termed epidermoid or pilar cysts, are typically harmless, slow-growing bumps under the skin. While they are usually painless, they can become inflamed or infected.

The most crucial piece of advice is to never attempt to squeeze, pop, or drain a cyst at home. Doing so can force bacteria deeper into the skin, leading to a painful infection, abscess formation, and significant scarring. It also fails to remove the cyst's underlying sac, making recurrence almost certain.

For minor, uninflamed cysts, applying a warm compress can help soothe the area and may encourage natural drainage. However, professional medical care is necessary if you notice signs of infection such as redness, swelling, pain, or a foul-smelling discharge. You should also see a doctor if a cyst grows rapidly, causes discomfort, or is located in a sensitive area.

A doctor will provide a definitive diagnosis and discuss treatment options. For an infected cyst, an incision and drainage procedure can relieve pressure and clear the infection. For permanent removal and to prevent recurrence, a complete surgical excision, which removes the entire cyst wall, is the most effective treatment. Following your doctor's aftercare instructions is vital for proper healing and minimizing scarring.

Please see below for treatment details.

Acne Treatment at KINS Clinic

Note: This article is for educational purposes only and does not constitute medical advice. Individual treatment plans should be developed in consultation with qualified healthcare professionals. Treatment outcomes vary from person to person, and no guarantee of results is intended or implied. All professional treatments mentioned should be performed by licensed medical practitioners in Singapore, using HSA-approved or otherwise MOH-approved products, devices, and techniques, as applicable.