Sebaceous cysts: what are they?

• Although they can appear anywhere on the body, the face, neck, and torso are the most common locations.
  They can be uncomfortable, but they are not life-threatening or cancerous.
• Apart from their appearance, skin cysts typically don’t cause any issues. Although they are typically not painful, their presence may be palpable.
• For instance, it could hurt if a cyst on the scalp gets caught on a brush or comb.
• Usually, cysts only hurt when they get inflamed or infected.

Performing an office procedure for an infected sebaceous cyst.

This is a 40-year-old gentleman who has had a sebaceous cyst for a few years. In the past couple of days, the cyst has become infected, which is why we are proceeding with drainage.

Important to note:

An infected sebaceous cyst cannot be stitched immediately, as suturing can trap infection and cause recurrence. Instead, we will drain the pus, remove the sebum and the cyst wall, and leave the wound open. The wound will then heal by secondary intention, or if it is healthy and uninfected after 2–3 weeks, we can stitch it.

Dr. Mir Asif from Mirascare Clinics, and will show you the step-by-step procedure.

Problem Area – Cyst is located

The cyst is located on the left shoulder and scapular region.

• We begin by prepping the area with Betadine.
• You can see the punctum and surrounding redness (erythema), which indicates inflammation.
• The cyst measures around 4 x 4 cm.

Since sebaceous cysts are subcutaneous structures arising from sebaceous glands, they cannot be pinched from the surface.

Local anesthesia

Dr. Mir Asif administers local anesthesia using Xylocaine combined with adrenaline. The patient experiences only a small prick during the injection. The temporary blanching of the skin that appears immediately is a normal effect caused by adrenaline, which induces vasoconstriction (narrowing of blood vessels).

This combination not only helps in reducing bleeding at the surgical site but also ensures that a safer dosage of anesthetic can be used while still providing effective and long-lasting pain control throughout the procedure.

During The Treatment

After making the incision, pus begins to pour out.

• It’s a foul-smelling discharge, which confirms infection.
• The patient will likely feel significant relief after drainage, as the pressure and infection are released.

Then Dr Mir Asif carefully remove the cyst wall along with the contents. This is crucial because leaving the wall behind may lead to recurrence.

The cavity is thoroughly washed and cleaned to remove any residual pus or debris.

• The cavity is approximately 2 to 2.5 inches deep.
• We leave the wound open and pack it with sterile gauze.

Post-procedure care:

• The patient will be prescribed antibiotics and painkillers.
• Pain after the procedure is usually minimal, and relief is often immediate compared to the discomfort of the infected cyst.
• Hygiene is not a cause of sebaceous cysts – they occur due to blocked sebaceous glands and sometimes genetic predisposition.

Post Recovery

 With that, the procedure is complete. The wound will heal gradually, and if required, delayed stitching can be done after 2–3 weeks.