Medical Care

Asymptomatic epidermoid cysts do not need to be treated. Intralesional injection with triamcinolone may hasten the resolution of inflammation. Oral antibiotics may occasionally be indicated.

Surgical Care

Epidermoid cysts may be removed via simple excision or incision with removal of the cyst and cyst wall though the surgical defect.^[39]If the entire cyst wall is not removed, the lesion may recur. Excision with punch biopsy technique may be used if the size of the lesion permits.^{[40, 41]}Minimal-incision surgery, with reduced scarring, has been reported.^{[42, 43]} An intraoral approach has been used to minimize facial scarring.^[44]

Incision and drainage may be performed if a cyst is inflamed. Injection of triamcinolone into the tissue surrounding the inflamed cyst results in faster improvement in symptoms. This may facilitate the clearing of infection; however, it does not eradicate the cyst.

Consultations

Lesions located in atypical locations warrant appropriate consultation.

Complications

Complications are rare, but they can include infection, scarring from removal, and recurrence. Malignancies in epidermoid cysts are very rare.

Prevention

When the cutaneous portion of a myocutaneous flap is to be buried, a dermatome should be used to remove the epidermis.

Guidelines

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Media Gallery

Unusually large epidermoid cyst with a prominent punctum on the back of a patient. (Ruler is in centimeters.)
Multiple epidermoid cysts on the forehead of a patient with Gardner syndrome.
Cyst containing keratinous material (hematoxylin and eosin, original magnification X1.6).
Higher-magnification view of the cyst wall of the cyst in Media File 3 demonstrates a true epidermis with a granular layer and adjacent laminated keratinous material (hematoxylin and eosin, original magnification X20).

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Author

Linda J Fromm, MD, MA, FAAD Private Practice, Fromm Dermatology at Health Concepts; Dermatologist, Rapid City Medical Center

Linda J Fromm, MD, MA, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Nathalie C Zeitouni, MDCM, FRCPC Chair of Dermatology, Associate Professor of Dermatology, Roswell Park Cancer Institute

Nathalie C Zeitouni, MDCM, FRCPC is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery, Women's Dermatologic Society, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Christen M Mowad, MD Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, Noah Worcester Dermatological Society, Pennsylvania Academy of Dermatology, American Academy of Dermatology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Julie C Harper, MD Assistant Program Director, Assistant Professor, Department of Dermatology, University of Alabama at Birmingham

Julie C Harper, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Received honoraria from Stiefel for speaking and teaching; Received honoraria from Allergan for speaking and teaching; Received honoraria from Intendis for speaking and teaching; Received honoraria from Coria for speaking and teaching; Received honoraria from Sanofi-Aventis for speaking and teaching.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Kenneth A. Becker, MD, and Isabelle Thomas, MD, to the development and writing of this article.

Epidermal Inclusion Cyst Treatment & Management

Medical Care

Surgical Care

Consultations

Complications

Prevention

References

Tables

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