An epidermal cyst or atheroma is formed when epidermal and other epithelial components become embedded in the dermis, which then proliferates to form a cyst (pouch) that contains a keratinous mass. It has been pointed out that epidermal components may become embedded due to injury or friction and human papilloma virus infection.
Presence of inflammation
Inflammation is an important factor to determine the the difficulty of the surgery, the postoperative appearance and the degree of pain.- When the epidermal cyst is inflamed, it will be difficult to take out the capsule. If the cyst remains, there is a higher risk of recurrence.
- Inflammation triggers tissue necrosis and takes time for the surrounding tissue to heal. This causes hyperpigmentation and leaves a noticeable scar. As the scar heals, the tissue shrinks and the skin becomes indented. This dent in the skin becomes more severe and more difficult to eliminate in proportion to the duration and severity of the inflammation.
- Inflammation also causes pain. This pain is caused by inflammatory mediators (such as bradykinin, ATP, protons) and sensitizers (prostaglandins) that are produced as a result of tissue destruction at the inflamed area. Therefore, even if local anesthesia is used during the surgery, the pain caused by the local anesthesia is felt more intensely. Xylocaine also causes the pH of the area to become acidic when tissue inflammation is severe. This reduces the amount of the base-type anesthetic, making it less effective.
Causes of Epidermal cysts
An epidermal cyst is a benign tumor that forms under the skin as a pouch fluid-filled of plaque, sebum or other waste products. This can be caused by infection of human papillomavirus(HPV) or by trauma to the skin, but such cases are rare. In most cases, they occur without a known cause.
Some people are also more prone to developing cysts than others and sometimes more than one develops. If these are left untreated, the bumps can gradually grow in size and become smelly. Inflammation due to bacterial infection may also occur. Once large and swollen, they are difficult to heal so we advise patients to have early consultation and treatment.
Reasons for Inflammation
When an epidermal cyst is inflamed by a bacterial infection, it becomes red and swollen with pain. Until now, it has been believed that this inflammation is caused by bacterial infection, but in recent years, inflammation caused by other causes have been reported in the United States.
As mentioned above, an epidermal cyst is a disease in which a pouch-like substance forms under the skin and waste accumulates inside it. However, it is thought that pressure on this pouch may result in it collapsing, causing the waste material to disperse into the skin, resulting in an inflammatory response. This type of inflammation is said to be more common than an inflammation caused by bacterial infection.
If the inflammation is not caused by a bacterial infection, it cannot be treated with antibiotics. To obtain sufficient therapeutic effect, prompt surgery is necessary. However, since it may be accompanied by a bacterial infection, antibiotics may be offered.
If the inflammation is severe, we will wait for it to subside and perform surgery after the inflammation has subsided.
Symptoms of Epidermal cysts
In the early stages of an epidermal cyst, the surface is not so raised and is just the size of a small lump that can be touched. However, the skin gradually becomes swollen as unexpelled sebum and keratin gradually accumulate inside.
When the waste material accumulates in the opening of the skin, a black spot (punctum) forms in the center of the bulging area.
When you press on the bump, a debris with a smell is ejected. The initial size of a mass is a few millimeters, but can grow to more than 10 cm in size.
A normal cyst is not particularly painful to touch. However, if it becomes inflamed and festering, it can be painful. If left untreated, the cyst can rupture.
Inflammation is often caused by bacterial infection and reaction to the accumulated substance, especially as a reaction to when the fluid inside of the cyst disrupts and leaks into the skin.
Surgical Methods for Cysts
Features of our surgery
- Surgery will be performed by a plastic surgeon to minimize scarring
- Speedy yet meticulous surgery (average of about 5 to 10 minutes)
- Surgery with minimal pain
- Depending on the condition of the cyst and other factors, either the punch incision or the incision method will be performed
- We can also treat cysts formed in the female genital area. A female doctor will be in charge
- Our doctors and staff will provide full support from surgery to aftercare
Elliptical excision
This is a common surgical method that has been used for a long time. The surgeon will make an elliptical(oval) cut in the skin and the entire cyst wall is removed. First the dermis, then the superficial layer is sutured.
| Advantages | The surgery can be performed for big cysts too. Stitches can be removed in about one week (depending which part of the body). |
|---|---|
| Disadvantages | Scars will be linear and longer than the punching incision method. The surgery cannot be performed in a case of inflammation. |
Punch incision
This is a method in which a small hole is made and the cyst wall is pulled out after the contents of the cyst have been removed.
For a normal-sized cyst, no sutures are needed since only a hole is made. If the cyst is slightly larger, minimal sutures are used.
If sutures are not used, it will take an average of 7-14 days to heal completely. If the cyst is large or severely inflamed, more time is needed.
| Advantages | Minimal scarring. Surgery can be performed even in the presence of inflammation. If stitches are not used, there is no need to remove them. |
|---|---|
| Disadvantages | Not suitable for large cysts. Therefore, an elliptical excision may result in faster healing of the lesion for big cysts. |
Cysts in female genitals
Because women have more secretory glands in the genital area, skin waste accumulates more easily than men and cysts are more likely to form. A lot of women tend to walk with their inner thighs and in addition to the friction from the underwear, this leads to thickening of keratin and accumulation of wastes.
When waste accumulates inside the skin, the human body tries to expel it by causing inflammation. Acne also occurs as a result of this process. The skin consists of a tissue called squamous epithelium, which constantly expels wastes such as sebum, plaque and sweat.
Since humans are unable to absorb waste into the body, when it is not properly expelled, it becomes inflamed and forms holes, which tries to expel the waste.
Inflammation can spread easily and cause swelling, especially in the genital areas because the skin is thin. Then the pain becomes intense and makes it difficult to even sit up.
At our clinic, a female doctor is available for treatment of cysts in the female genitals, so please feel free to consult with us.
For prevention
Causes of skin wastes that are not excreted properly include delayed skin turnover and thickening of keratin due to friction.
As the skin thickens, the glands that produce secretions become blocked, further increasing the accumulation of waste. Preventing a cyst requires exfoliating the skin with peels along with wearing underwear that does not cause friction.
If you would like to know about other ways to prevent cysts, please do not hesitate to contact us.
Surgical procedures
1Consultation, diagnosis and consent to treatment
A medical interview and palpation are performed to check the size of the lump and to confirm whether there is a possibility of a lipoma or other tumors. Some patients may be asked to undergo imaging tests such as ultrasound echo. Based on the results of the examination, we will explain the surgical procedure and its risks. If the patient agrees to the details of the surgery, the surgery will be performed.
2Local anesthesia and surgery
Local anesthesia is given to the affected area. As soon as the anesthesia is effective, incision of the affected area will start. After removing the contents of the cyst and the pouch, we check for any remaining capsular tissue and perform minimal suturing. Once suturing is complete, the surgery is over.
3Postoperative follow-up
After the surgery, you will be asked to refrain from bathing, drinking and exercising as bleeding is likely to occur. You may shower the next day. It will take 1-2 weeks for the wound to heal. During this time, you will be asked to return to the clinic for observation. (The number of visits may vary depending on the condition of the patient before and after the surgery.)
*If the cyst is large or highly inflamed, if you are taking medication that makes it difficult to stop bleeding, or if it is in a location that you cannot see, you may be asked to return to the clinic several times during the first week after the surgery.
4Pathological Examination
Tumors removed by surgery are examined by pathology before a final diagnosis is made. Approximately one month after the surgery, the patient will return to the clinic for a follow-up visit. At the same time, the results of the pathological examination will be explained. Also during the return visit, we will also check to see if the wound has healed properly.