Definition & Overview

Cysts are pockets of tissue that form under the skin. These are closed and are filled with fluid. Although non-cancerous, they can cause discomfort, may be painful if they rupture, may get inflamed, and are very prone to infection.

Cysts form in the body due to many possible skin conditions; thus, they also come in many different types. These include:

  • Skin cysts – These are painless, skin-colored lumps that can appear anywhere on the body.

  • Sebaceous cysts – Also known as epidermoid cysts, these are benign cysts that form on the hair follicle and are commonly found on the chest, back, or genitals.

  • Cherry angioma – Also known as Campbell de Morgan’s spot, these are cherry-red colored bumps on the skin surface that occurs most commonly on the trunk of people aged 40 and older.

  • Dermatofibromas – Reddish or brownish round bumps that usually appear on the legs or arms. They may feel like hard lumps.

  • Folliculitis – Cysts formed due to inflamed hair follicles that most commonly occur on the face and scalp.

  • Keratoacanthoma – These cysts are caused by abnormal cell growth due to a past skin injury. They most commonly occur among people over age 60 and in body parts that have previously experienced sun damage.

  • Keratosis pilaris – These are white or red cysts that have a rough surface. They are most common during the winter months.

  • Lipomas – Lipomas are slow-growing, harmless, subcutaneous tumours that are made up of soft tissue, thus giving them a rubbery consistency. These are most common on the neck, shoulders, and trunk.

Cause of Condition

Cysts can be caused by several factors, such as:

  • Infection
  • Clogged oil glands, also known as sebaceous glands
  • A reaction to foreign objects attached to the skin, e.g. earrings
  • Scar tissue
  • Chemical irritation
  • Friction from tight clothing
  • Shaving
  • Abnormal cell growth
  • Minor skin injury
  • Sun damage from ultraviolet radiation
  • Skin dryness
  • Pregnancy and childbirth
  • Groups of cysts clustered together

Some ongoing health problems may also increase a person’s risk of getting cysts; these include:

  • Weakened immune system
  • Diabetes
  • Obesity

Some cysts, such as cherry angioma and dermatofibromas, have unknown causes.

Key Symptoms

Here are some key symptoms of the different types of cysts to help you determine whether you have a cyst and what type it is.

Skin cyst

  • Feels like peas under the skin
  • Grows slowly or does not grow at all
  • Painless
  • Has a smooth surface
  • Tends to roll when pressed

Sebaceous cyst

  • Round
  • May be skin-colored or may look darker
  • Becomes red and tender when infected
  • Can release a white discharge when squeezed or when they rupture

Dermatofibromas

  • A round growth that changes color from red to brown or purple
  • Tenderness
  • Pain
  • Itching
  • Creates a dimple when the growth is pinched

Folliculitis

  • Has a papule or pustule in the middle
  • Has a hair in the center
  • Several red bumps in body parts that have hair
  • Itchy skin

Keratoacanthomas

  • Thick growth
  • Dome-shaped bump around 1-3 inches in diameter
  • Have a crusted plug in the center

Who to See & Types of Treatments Available

If you have a cyst or any abnormal lump or bump under the skin, it helps to have a doctor conduct a checkup, regardless of whether the cyst causes pain or not. This is to make sure the cyst is safe and is not infected. Since most cysts go away on their own after a while, your primary care physician or internist would tell you whether treatment is necessary for your specific case.

If treatment is required, you will be referred to a dermatologist, a doctor specializing in diagnosing and treating problems of the skin.

You can also approach other health professionals depending on the type and location of cysts you have. For example, if you have a genital cyst, you can see an obstetrician-gynecologist for treatment.

Treatment also depends on the type of cyst you have:

  • Skin cysts. The treatment procedure will depend on whether the cyst is infected or not. If it is not infected, the cyst will simply be drained by piercing it and draining its contents. This will immediately reduce the size or completely get rid of the lump. However, there is a possibility of the cyst recurring. If a cyst is inflamed or infected, your doctor may inject a cortisone medication before shrinking it. If a cyst does not respond to the medication, it can be surgically removed.

  • Sebaceous cysts. To get rid of a sebaceous cyst, its sac, which contains the white discharge, has to be removed. If the discharge is squeezed out without removing the sac, the cyst is highly likely to recur. Sebaceous cysts can become infected; if this happens, your doctor will prescribe antibiotics to get rid of the infection before removing the cyst.

  • Cherry angioma. Most of the time, angioma cysts do not need treatment, but if they are prone to bleeding or if the appearance bothers you due to their location, they may be removed by electrocautery (burning and destroying the tissue) or the more common laser surgery. Both treatment options may leave behind a scar.

  • Dermatofibromas. These cysts are either frozen with liquid nitrogen and flattened or are surgically removed.

  • Folliculitis. The treatment of folliculitis will depend on what caused the infection in the first place; it can be treated with topical or oral antibiotics if there is bacterial infection or with an antifungal cream if the cause is a fungal infection. It is also important to avoid wearing tight clothing and shaving, and to clean the area often; these steps will help prevent the cyst from recurring.

  • Keratoacanthomas. These skin growths require treatment and removal since they are considered as a low-grade skin cancer. First, the growth is removed either through surgery, cryotherapy (freezing and removing) or curettage (burning and scraping off). Next, a cancer drug is then directly injected into the lesion of the growth.

  • Keratosis Pilaris. Keratosis pilaris does not medically require treatment, but most people who have these growths have it removed usually due to cosmetic reasons. To treat this cyst, the area of growth should first be intensively moisturized; your doctor can prescribe the necessary medication, such as AmLactin or LadHydrin creams, which can be applied repeatedly every day. Next, the growth has to be gradually exfoliated; you can do this every day by rubbing it with a brush or washcloth when taking a bath.

  • Lipomas. Lipomas do not require treatment, unless they compress the nerves, which can cause some pain. Some people also ask for treatment for cosmetic reasons, whereas some doctors prescribe standard excision if there is no accurate diagnosis as to what caused the cyst to form. If the growth is too large, lipectomy or the removal assisted by liposuction, may be necessary; this can cause minimal scarring on the affected area.
    References:

  • Warvi W, Gates O. (1943). “Epithelial cysts and cystic tumours of the skin.” The American Journal of Pathology.

  • Stevens D, Bisno A, Chambers H, Everett ED, Dellinger P, et al. “Practice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections.” Clinical Infectious Diseases, Oxford Journals.
  • Luba M, Bangs S, Mohler A, Stulberg D. (2003). “Common Benign Skin Tumours.” American Family Physician.
  • Christenson L, Patterson J, Davis D. (2000). “Surgical pearl: Use of the cutaneous punch for the removal of lipomas.” Journal of the American Academy of Dermatology.
  • Lanigan SW, Robinson TW. (1987). “Cryotherapy for dermatofibromas.” Clin Exp Dermatol.
  • Schwartz RA. (1994). Keratoacanthoma.” Journal of the American Academy of Dermatology.
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