WATCH : Milk Incision & Drainage From Neck

This patient has been seeing Dr Rebish recently because he has had this cyst on his neck which has recently become inflamed and “infected”. I put “infected” in quotes, because technically this is not an infection: When an epidermoid cyst ruptures, it creates a vigorous foreign body inflammatory response – this skin becomes warm, tender, painful, and swells, simulating an abscess. Incision and Drainage (I & D), will confirm the diagnosis of inflamed cyst, when the smelly, cheesy material is evacuated, and this often leads to rapid resolution of symptoms. These episodes are often misdiagnosed as “infection” of the cyst, but cultures are usually negative and antibiotic treatments is not required. Intralesional steroids can hasten the resolution of symptoms as well.

All this being said, we often prescribe antibiotics- it’s hard not to when you see something so red and inflamed and painful.. it seems almost cruel not to! Also, we as dermatologists, will just call the cyst infected, or call it an abscess. It’s more difficult to explain to patients why we would not call an area that looks angry and red and is painful non-infected. However, I felt I needed to clarify all of this in detail here, for medical education purposes

Consider getting a second opinion if you are not satisfied with your physician’s diagnosis and treatment. Although most epidermoid and pilar cysts do not require treatment from a physician, if you do seek medical advice and are not satisfied with the results seek a second opinion. Most sebaceous and epidermoid cysts are straightforward, but there are other conditions that may mimic these cysts.

Anyway, Dr Rebish had been injecting the area with steroids to decrease the inflammation but he had an appointment with me to finally excise the area because he was fed up with it. When I saw it, we prepared for an excision, but it actually turned into an I & D, the cyst was completely broken down because it had ruptured.

Use a wet, warm compress over an epidermoid cyst to encourage it to drain and heal. The washcloth should be hot but not so hot that it burns the skin. Place it over the cyst two to three times a day.
Cystic acne responds better to ice than it does to heat.
Bartholin gland cysts can be treated at home using warm water sitz baths. This involves sitting in several inches of warm water to encourage the cyst to drain.

Refrain from picking, squeezing, or trying to pop either an epidermoid cyst or sebaceous cyst. This can increase the risk of infection and scarring. Also, never pick, squeeze or attempt to pop a cystic acne. This drives the infection deeper and increases the risk of scar tissue.

Allow an epidermoid cyst to drain naturally. Once it begins to drain, cover it with a sterile dressing, which you can change twice a day. If a large amount of pus begins to drain from the cyst, the skin surrounding the cyst turns red, the area becomes warm and tender, or blood begins to drain from the cyst, it is time to seek medical care.

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