eMedicine Specialties > Dermatology > Benign Neoplasms

Pilar Cyst: Treatment & Medication

Author: Anne Laumann, MB, ChB, MRCP(UK), FAAD, Associate Professor, Department of Dermatology, Feinberg School of Medicine, Northwestern University
Coauthor(s): Jenneé A Rommel, MD, Resident Physician, Combined Internal Medicine/Dermatology Residency Program, Washington Hospital Center, Georgetown University School of Medicine; Marjan Mirzabeigi, MD, Fellow in Dermatopathology, Department of Dermatology, Northwestern University
Contributor Information and Disclosures

Updated: Mar 25, 2009

Treatment

Medical Care

Painful, swollen, erythematous, and/or purulent cysts may indicate the presence of an infection. Empiric treatment with an oral antistaphylococcal antibiotic or a wound culture with directed therapy may be necessary.8

Surgical Care

Definitive treatment is complete excision of the cyst. Several methods can be used to surgically remove these cysts. A small linear incision, an elliptical excision, and a circular dermal punch incision all are effective ways to remove the cysts.13


<BR>Surgical removal of an intact pilar cyst thro...


Surgical removal of an intact pilar cyst through an elliptical excision.

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<BR>Surgical removal of an intact pilar cyst thro...


Surgical removal of an intact pilar cyst through an elliptical excision.


For all methods, the procedure involves the following steps:

  1. Anesthetize the area with local anesthetic.
  2. Over the center of the cyst, make a small linear incision, an elliptical excision, or a punch incision using a dermal punch biopsy tool.
  3. Express the contents of the cyst, and then, using a curette, press against the inner wall, moving it back and forth to dislodge it from the surrounding tissue. Many times, the fibrous capsules of pilar cysts are thick enough that the cyst can be easily removed intact via blunt dissection without expression of the contents.
  4. Grasp the edge of the cyst with forceps and separate the cyst wall from the surrounding connective tissue via blunt dissection.
  5. Control the bleeding, and suture or dress the wound as necessary.


<BR>Closure of the defect after surgical removal ...


Closure of the defect after surgical removal of the pilar cyst.

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<BR>Closure of the defect after surgical removal ...


Closure of the defect after surgical removal of the pilar cyst.


If the cyst is ruptured or infected, deferring excision until inflammation is reduced decreases the likelihood of problems with wound healing.8

The therapeutic approach in cases of the rare proliferating trichilemmal cyst is complete surgical removal. Additional radiotherapy and/or chemotherapy may occasionally be considered.14

More on Pilar Cyst

Overview: Pilar Cyst
Differential Diagnoses & Workup: Pilar Cyst
Treatment & Medication: Pilar Cyst
Follow-up: Pilar Cyst
Multimedia: Pilar Cyst
References
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References

  1. Casas JG, Woscoff A. Giant pilar tumor of the scalp. Arch Dermatol. Dec 1980;116(12):1395. [Medline].

  2. Al-Khateeb TH, Al-Masri NM, Al-Zoubi F. Cutaneous cysts of the head and neck. J Oral Maxillofac Surg. Jan 2009;67(1):52-7. [Medline].

  3. Wolff K, Johnson RA, Suurmond D. Miscellaneous Cysts and Pseudocysts. In: Seils A, Englis MR, eds. Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology. 5th ed. New York, NY: McGraw-Hill; 2005:200.

  4. Leppard BJ, Sanderson KV, Wells RS. Hereditary trichilemmal cysts. Hereditary pilar cysts. Clin Exp Dermatol. Mar 1977;2(1):23-32. [Medline].

  5. Weiss J, Heine M, Grimmel M, Jung EG. Malignant proliferating trichilemmal cyst. J Am Acad Dermatol. May 1995;32(5 Pt 2):870-3. [Medline].

  6. Kirkham N. Tumors and Cysts of the Epidermis. In: Elder DE, Elenitsas R, Johnson BL, Murphy GF, Xu X, eds. Lever's Histopathology of the Skin. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2004:694-7.

  7. Cotton DW, Kirkham N, Young BJ. Immunoperoxidase anti-keratin staining of epidermal and pilar cysts. Br J Dermatol. Jul 1984;111(1):63-8. [Medline].

  8. Valencia TD, Swanson NA, Lee KK. Benign Epithelial Tumors, Hamartomas, and Hyperplasias. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest B, Paller AS, Leffell DJ, eds. Fitzpatrick's Dermatology in General Medicine. Vol 1. 7th ed. New York, NY: McGraw-Hill; 2008:1064-5.

  9. Ivan D, Bengana C, Lazar AJ, Diwan AH, Prieto VG. Merkel cell tumor in a trichilemmal cyst: collision or association?. Am J Dermatopathol. Apr 2007;29(2):180-3. [Medline].

  10. Su W, Kheir SM, Berberian B, Cockerell CJ. Merkel cell carcinoma in situ arising in a trichilemmal cyst: a case report and literature review. Am J Dermatopathol. Oct 2008;30(5):458-61. [Medline].

  11. Eiberg H, Hansen L, Hansen C, Mohr J, Teglbjaerg PS, Kjaer KW. Mapping of hereditary trichilemmal cyst (TRICY1) to chromosome 3p24-p21.2 and exclusion of beta-CATENIN and MLH1. Am J Med Genet A. Feb 15 2005;133A(1):44-7. [Medline].

  12. Hanau D, Grosshans E. Trichilemmal cyst with intrinsic parietal sebaceous and apocrine structures. Clin Exp Dermatol. Sep 1980;5(3):351-5. [Medline].

  13. Mehrabi D, Leonhardt JM, Brodell RT. Removal of keratinous and pilar cysts with the punch incision technique: analysis of surgical outcomes. Dermatol Surg. Aug 2002;28(8):673-7. [Medline].

  14. Satyaprakash AK, Sheehan DJ, Sangueza OP. Proliferating trichilemmal tumors: a review of the literature. Dermatol Surg. Sep 2007;33(9):1102-8. [Medline].

  15. McGavran MH, Binnington B. Keratinous cysts of the skin. Identification and differentiation of pilar cysts from epidermal cysts. Arch Dermatol. Oct 1966;94(4):499-508. [Medline].

  16. Pinkus H. "Sebaceous cysts" are trichilemmal cysts. Arch Dermatol. May 1969;99(5):544-55. [Medline].

  17. Rook A, Wilkinson DS, Ebling FJG, et al, eds. Trichilemmal cyst. In: Textbook of Dermatology. Vol 2. 6th ed. London, England: Blackwell Science; 1998:1667-8.

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Further Reading

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Keywords

pilar cysts, trichilemmal cysts, scalp cysts, benign cysts, keratinizing cyst, proliferating pilar cysts, proliferating pilar tumor

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Contributor Information and Disclosures

Author

Anne Laumann, MB, ChB, MRCP(UK), FAAD, Associate Professor, Department of Dermatology, Feinberg School of Medicine, Northwestern University
Anne Laumann, MB, ChB, MRCP(UK), FAAD is a member of the following medical societies: American Academy of Dermatology, Association of Professors of Dermatology, Chicago Dermatological Society, Chicago Medical Society, Illinois Dermatological Society, Illinois State Medical Society, Illinois State Medical Society, Medical Dermatology Society, and Society for Investigative Dermatology
Disclosure: Boerhinger-Ingelheim Consulting fee Consulting; Pfizer Consulting fee Consulting; Astellas Consulting fee Consulting; Alza J and J Grant/research funds Other; Amgen Grant/research funds Other; Basilea Grant/research funds Other; OSI Pharmaceuticals  Other; Centocor Grant/research funds Other; Lilly-ICOS Grant/research funds Other; Bavarian Nordic Grant/research funds Other

Coauthor(s)

Jenneé A Rommel, MD, Resident Physician, Combined Internal Medicine/Dermatology Residency Program, Washington Hospital Center, Georgetown University School of Medicine
Disclosure: Nothing to disclose.

Marjan Mirzabeigi, MD, Fellow in Dermatopathology, Department of Dermatology, Northwestern University
Marjan Mirzabeigi, MD is a member of the following medical societies: American Society for Clinical Pathology and College of American Pathologists
Disclosure: Nothing to disclose.

Medical Editor

R Stan Taylor, MD, Professor of Dermatology, University of Texas Southwestern Medical School; Director of Skin Surgery and Oncology Clinic, Department of Dermatology, University of Texas Southwestern Medical Center
R Stan Taylor, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, Christian Medical & Dental Society, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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