Skin Cyst Symptoms, Causes & Treatment Options

Skin cysts are round, protruding growths beneath the skin that may drain a semi-liquid substance through a central pore. Cysts are mostly benign and they can usually be removed by a small surgical procedure.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is A Skin Cyst?

Summary

Skin cysts (a group of skin conditions including epidermoid cysts, pilar cysts, milia, and others) are benign, mobile, round, firm growths beneath the skin that may drain a cheesy substance through a central pore. Cysts are generally harmless, and treatment is usually not required, though cysts can be removed if they are bothersome. Cysts can be treated definitively by surgical excision, a procedure that usually takes place under local anesthetic in a dermatologist’s office. Inflamed or infected cysts may require more urgent treatment, so they do not progress into more harmful infections.

Recommended care

Skin Cyst Symptoms

Main symptoms

A cyst is defined as any closed pocket of tissue, filled with a fluid or fluid-like material. Many skin conditions fit this definition of “cyst;” however, when people speak about skin cysts, they are most commonly referring to two common conditions – the epidermoid cyst and the pilar cyst. These and similar cysts will present with the following features:

  • Nodule: The defining feature of a cyst will be a round nodule under the skin. The cyst will typically be round and protruding. It can be any size from several millimeters to several centimeters. The round “ball” of cyst contents may feel soft or hard, and may be mobile under the skin or fixed.
  • Normal skin color: Unless it has become inflamed or infected, the skin overlying the cyst should be your normal skin coloration and texture, without pain, itching, or irritation.
  • Opening or pore: Cysts often have one or multiple pores that may cause them to resemble large comedones, or “black-heads.” If pores are present, a soft, yellowish, semi-solid substance (usually keratin) may drain from or be squeezed from the cyst.
  • Inflammation: Sometimes, a cyst will become infected or inflamed. In these cases, the skin overlying the cyst may become red and irritated, the cyst may become painful, and drainage from the cyst may increase.

Cyst-specific features

Cysts can be sub-divided into many types. Some specific cyst types and their features are listed below:

  • Epidermoid inclusion cyst: These occur most often on the face and trunk.
  • Pilar cyst: These firm cysts occur mostly on the scalp and may be especially likely in areas that have undergone alopecia (balding).
  • Milia: Milia are smaller cysts, generally measuring 1-2 millimeters in diameter. They are usually pale or white in color and may be initially confused with a whitehead. They occur most often on the face, especially around the eye, and can affect both infants and adults.
  • Pilonidal cyst: Pilonidal cysts usually occur at the upper portion of the gluteal cleft and most commonly affect young men. These cysts will often form a draining sinus tract and may become infected [1].

Skin Cyst Causes

An epidermoid inclusion cyst is a benign growth of the epidermis (the top layer of the skin), that occurs within the dermis (a lower layer of the skin). This can occur when a hair follicle becomes plugged, after an injury, or sporadically. Pilar and other cysts occur by a similar mechanism.

Cysts are common, occurring in roughly 20% of adults. They can happen any time from birth to late life. Men are affected slightly more often than women. Cysts are not contagious.

Some further explanation of cyst causes is below:

  • Sporadic: Skin cysts are mostly sporadic, meaning they occur in a random pattern. Surgery or piercing: An injury, like a surgery or piercing, can trigger a cyst to form.
  • Acne: Cysts often occur in areas where hair follicles have become inflamed in the past – often this correlates with acne [2].
  • Rarely, as a part of a syndrome (Gardners): Certain genetic syndromes may cause epidermoid or other cysts to form frequently, and may cause multiple cysts at a time. Sometimes these conditions (like Gardner Syndrome for example), can be associated with other cancers, so if you have multiple or frequent cysts you should follow up with a specialist [1]. Some other syndromes that have been associated with cysts include Favre-Racouchot syndrome and Gorlin syndrome [2].
  • Inflammation: Some cysts will become inflamed. There are very few if any reliable factors that can predive if a cyst will grow larger, become inflamed, or remain the same.
  • Certain medications: Medications like imiquimod and cyclosporine may lead to a higher frequency of skin cysts on the face [2].

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Treatment Options, Relief, and Prevention for Skin Cysts

Treatment

Skin cysts are generally benign growths, and once a dermatologist has diagnosed a cyst and ruled out more dangerous alternatives, treatment is not completely necessary. Still, cysts will often be removed if they are causing discomfort or altering appearance. Additionally, inflamed or infected cysts should be treated or removed to prevent progression of the cyst to a more serious infection.

  • Do nothing: If a cyst is not inflamed (not painful, red, hot, or growing rapidly), and it does not bother you, it is completely benign (not dangerous) and it is not necessary to have it excised. You should still visit a doctor for a definitive diagnosis.
  • Surgical excision: The definitive treatment for skin cysts like epidermal inclusion cysts is surgical excision. This procedure will take place in a dermatologists office under local anesthesia. Optimally, the excision will remove the entire wall of the cyst, in which case recurrence is unlikely. It is best to perform excision when the cyst is not inflamed.
  • Milia excision: Excision of milia is often simpler than excision of a larger cyst, and may only require puncture with a needle or a nick with a sharp blade. This procedure should still be performed in a doctor’s office.
  • Inflamed cyst: If a cyst is inflamed, but excision is desired, an injection of corticosteroids like triamcinolone (Kenalog) can calm inflammation to allow for sooner excision.
  • Fluctuant inflamed cyst: A fluctuant inflamed cyst is one that is especially painful, swollen, draining fluids, infected and inflamed. In the case of a fluctuant inflamed cyst, the lesion should be urgently excised, with postoperative wound packing and antibiotics active against methicillin-resistant staph aureus.

Prevention

Certain factors, like acne, trauma, and medications like imiquimod and cyclosporine may increase the likelihood of developing skin cysts to some degree. Aside from avoiding these risk factors to whatever extent possible, there is no known way to prevent cysts from occurring.

You can prevent complications of cysts, like rupture, infection, and scarring, by not attempting to drain cysts at home. Refrain from squeezing or opening cysts outside of a doctor’s office for your safety!

When to Seek Further Consultation for Skin Cysts

If you think you have a cyst, you should see a dermatologist for confirmation of the diagnosis. Even though cysts are benign, they can look quite similar to cancers of the skin and soft tissues of the body, which can be deadly.

If you have a diagnosed cyst, you can have it removed if you feel that it is irritating, or you do not like its appearance, or if it does not bother you, you can choose to do nothing.

If a cyst is red, painful, swollen, or draining fluid, it may be inflamed or infected, and you should seek medical consultation. Inflamed or infected cysts may need urgent drainage, as they can progress to more serious skin infections.

Finally, if you have multiple or recurrent cysts, be sure to mention this to a dermatologist to be sure that your cysts are not part of an underlying medical condition [3].