Dermatology Book

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Epidermal CystAka: Epidermoid Cyst, Epidermal Inclusion Cyst, Sebaceous Cyst, Epithelial Cyst, Keratin Cyst

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  1. See Also
    1. Pilar Cyst
    2. Sebaceous Gland
  2. Etiologies
    1. Ruptured Pilosebaceous Follicle (acne comedone)
    2. Local trauma buries surface epithelium under skin
  3. Pathophysiology
    1. Common Locations
      1. Face
      2. Ears
      3. Chest
      4. Back
    2. Lesion
      1. Cyst wall: stratified squamous epithelium
      2. Cyst contents
        1. Does not contain Sebaceous Glands
        2. Keratin and lipid
        3. Breakdown products
        4. Bacterial infection
    3. Cyst rupture effect (keratin spills into Dermis)
      1. Significant inflammation
      2. Lesion may scar or become infected
  4. Symptoms
    1. Usually asymptomatic
    2. Soft, yellow keratin discharge may have foul odor
  5. Signs
    1. Round, mobile, smooth surfaced mass
    2. Slow growing lesion from 5 mm to 5 cm in diameter
    3. Visible pore may be present at center of lesions
    4. May be inflamed if syst has ruptured
  6. Differential Diagnosis
    1. See site specific (e.g. Neck Masses in Children)
    2. Lipoma
    3. Milia (1-2 mm lesion)
      1. Puncture with needle, express with comedone extractor
    4. Dermoid cyst
      1. May extend intracranially (CT Head before excision)
      2. Locations
        1. Follow Cleavage Lines
        2. Sublingual
        3. Periorbital
        4. Base of nose
    5. Gardner's Syndrome (Associated with Colonic Polyps)
      1. Children with sebaceous cysts
      2. Adults with sebaceous cysts in rare location (leg)
      3. Multiple Lipomas, fibromas, Osteomas
  7. Variations with multiple lesions
    1. Steatocystoma Multiplex
      1. Numerous 2-3mm lesions on trunk, arm, axilla, thigh
    2. Favre-Racouchot Syndrome
      1. Multiple facial lesions due to sun damage
  8. Management
    1. Non-inflamed cyst
      1. Small to moderate sized cysts
        1. See Minimal Epidermal Cyst Excision
      2. Large Cysts (2 cm or larger)
        1. Complete excision in standard fashion
        2. Remove cyst intact via Blunt Dissection
    2. Inflamed cyst
      1. Warm compresses
      2. Incision and Drainage
  9. References
    1. Habif (1996) Clinical Dermatology, p. 644
    2. White (1994) Regional Dermatology, p. 27
    3. Zuber (2002) Am Fam Physician 65(7):1409

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