Sebaceous Cysts

A cyst is a benign, encapsulated growth that forms a sac beneath the skin and is filled with fluid, semi-fluid material, or debris. Cysts vary widely in size, shape, and location. While most are harmless, they can become uncomfortable, inflamed, or cosmetically bothersome over time. Among the many types of skin cysts patients bring to a dermatology practice, sebaceous, epidermoid, and pilar cysts are the most commonly diagnosed, and board-certified dermatologist Dr. Michele Green in Manhattan regularly evaluates and treats each.

Sebaceous cysts are slow-growing, noncancerous bumps that form when a hair follicle or pore becomes clogged with sebum, dead skin cells, and keratin, creating a fluid-filled lump beneath the skin. Left untreated, these cysts can enlarge, become infected, and cause unwanted scarring, which is why early evaluation matters. Dr. Michele Green treats sebaceous, epidermoid, and pilar cysts every day in her Upper East Side, NYC, office, using minimally invasive techniques to remove these growths while avoiding unnecessary scarring.

Dr. Michele Green is an expert in diagnosing and treating sebaceous, epidermoid, and pilar cysts, as well as other benign skin growths, at her private practice on the Upper East Side of NYC. A board-certified dermatologist with over 25 years of experience, Dr. Green specializes in removing skin cysts and remains at the forefront of safe, minimally invasive techniques. Dr. Green takes a careful, individualized approach to cyst removal, helping each patient achieve smooth, healthy-looking skin with minimal downtime and scarring.

What is a Cyst?

A cyst is a benign, encapsulated lesion consisting of a sac that contains fluid or semi-fluid material. Cysts can vary considerably in shape, size, and location on the body.

Acne, acne cysts, and sebaceous cysts are among the most common types of skin cysts that bring patients to a dermatology practice like Dr. Michele Green’s in Manhattan. Sebaceous cysts, in particular, are slow-growing, noncancerous bumps on the skin. If left untreated, they tend to enlarge, become infected, and cause cosmetic scarring. Dr. Green treats sebaceous cysts in her Upper East Side office, using minimally invasive techniques that address the cyst in a cosmetically elegant way while avoiding unnecessary scarring.

Types of Cysts

Sebaceous Cysts

A sebaceous cyst resembles a large pimple or a fluid-filled lump and, like acne, forms within or near hair follicles. These benign, firm growths appear as small lumps under the skin when dirt, excess oil, or a buildup of dead skin and sebum becomes trapped by a clogged hair follicle or pore. Sebaceous cysts can grow rapidly, sometimes enlarging over days or weeks.

These cysts most commonly appear on the face, upper back, scalp, and chest, where most sebaceous glands are concentrated. They do not occur on the palms of the hands or the soles of the feet. The overlying skin is usually flesh-colored or yellow due to the buildup of sebum, pus, and keratin. While many sebaceous cysts are initially painless, larger ones can become painful over time. Most sebaceous cysts are not life-threatening and may resolve on their own, though others require further treatment. Depending on the cyst’s location, the degree of discomfort, the risk of infection, and the cosmetic impact, Dr. Green will determine at her NYC office whether treatment and removal are necessary.

Epidermoid Cysts

Epidermoid cysts, also called epidermal cysts, are among the most common types of skin cysts. They result from the proliferation of epidermal cells within the dermis, typically forming at or near a hair follicle. These small lumps under the skin contain dead skin cells and typically appear flesh-colored or yellow. Epidermoid cysts are most often found on the face, neck, back, or scrotum, and they generally develop in areas with little hair. They commonly form when a hair follicle becomes clogged with keratin, the protein responsible for skin cell regeneration; the epidermal cells that form the cyst wall secrete keratin into the cyst. When formed as a result of trauma, these growths are known as epidermal inclusion cysts, and if irritated, inflamed, or infected, they can become quite painful.

Men are more than twice as likely as women to develop epidermoid cysts, and most arise in adulthood. Patients prone to epidermoid cysts should be evaluated for an underlying skin condition, such as Gardner syndrome or familial adenomatous polyposis. Although these cysts are generally benign, rare cases of skin cancer, including basal cell carcinoma, have arisen from an epidermoid cyst. To successfully treat an epidermoid cyst, the entire cyst wall must be removed; if any portion remains, the cyst can recur.

Pilar Cysts

Pilar cysts, also called trichilemmal cysts or wens, are benign growths that occur predominantly on the scalp. These flesh-colored bumps can vary in size from that of a nickel to that of a golf ball. As they enlarge, they form a smooth, dome-like bump that is firm to the touch. The larger a pilar cyst grows, the more pressure and discomfort it can cause. Trauma to the area can cause the cyst to rupture, leading to pain and infection. Pilar cysts are hereditary and are more common in middle-aged women than in men.

While pilar cysts are benign, many patients opt for surgical removal because of the size, pressure, or discomfort they cause, as well as for cosmetic reasons. It is important that both the cyst and its epithelial lining be removed to help prevent the pilar cyst from recurring.

Symptoms of Sebaceous Cysts

A lump or growth beneath the skin is usually the first sign of a developing sebaceous cyst. The cyst may initially feel soft, gradually becoming firmer as keratin builds up within the cyst wall. Most remain benign and painless at first, though depending on their location, they can become irritated, erythematous, and inflamed, which may indicate an underlying infection. If the cyst becomes tender to the touch and the surrounding skin appears red and warm, it may be infected and require treatment, which can include draining the cyst and prescribing oral antibiotics. A foul-smelling discharge, fever, or other systemic symptoms strongly indicate infection and warrant prompt medical attention.

While most sebaceous cysts are not cancerous, this possibility cannot be ruled out entirely. A sebaceous cyst may be considered abnormal or possibly cancerous if its diameter exceeds five centimeters or if it continues to recur in the same location after repeated removal.

Causes of Sebaceous Cysts

Sebaceous cysts form within the sebaceous glands, which produce sebum, when a hair follicle becomes clogged with a buildup of sebum or keratin. These cysts can also develop from pimples or as a result of trauma to the sebaceous glands. Patients with a genetic predisposition, such as steatocystoma multiplex, Gardner syndrome, or Basal Cell Nevus Syndrome, are more likely to develop sebaceous cysts.

How Do You Diagnose a Sebaceous Cyst?

A dermatologist, family physician, or other healthcare provider can typically diagnose a sebaceous cyst through a physical examination, which also helps rule out conditions such as basal cell carcinoma. Sometimes, additional testing is needed to confirm the diagnosis, since a cyst can be mistaken for another type of skin tumor.

Common tests used to diagnose a sebaceous cyst include:

• CT scan – performed to rule out other abnormalities or cancer.
• Ultrasound – performed to determine the cyst’s contents and the depth of inflammation.
• Punch biopsy – performed to determine the cyst’s histology.
• Culture and Sensitivity – performed to identify the bacteria responsible for an infection and the best antibiotic to treat it.

What Is the Best Treatment for a Sebaceous Cyst?

Depending on the size and severity of the sebaceous cyst, treatment options range from drainage to surgical excision. In dermatology, most cysts are removed because of their cosmetic appearance or the discomfort they cause. A board-certified dermatologist, such as Dr. Green in NYC, will discuss the best treatment for your cyst based on her clinical evaluation; some larger cysts, or those on the face, may require a plastic surgeon. The right treatment depends on the cyst’s anatomic location, size, and whether it is already infected, and Dr. Green will guide your care to provide the best aesthetic and medical outcome.

Sebaceous cysts can be removed using the following techniques:

• Incision and drainage – If the cyst is infected, it is drained, and the contents are cultured for antibiotic susceptibility; oral antibiotics are then prescribed to treat the infection and allow the wound to heal. This technique is used when the entire cyst cannot be removed at the time due to infection.
• Intralesional injection with cortisone – Inflamed cysts can be treated with a steroid injection, which reduces inflammation and allows a small sebaceous cyst to shrink.
• Minimal excision – This technique removes the cyst with minimal scarring, though it does not always guarantee that the entire cyst wall is removed, so there is some risk of recurrence.
• Conventional wide excision – This procedure completely removes the cyst and its contents, including the cyst wall, to prevent recurrence, though scarring is inevitable. The area is anesthetized with local anesthesia before the entire cyst, including the cyst wall, is surgically removed.

After removing a cyst, Dr. Green prescribes oral and topical antibiotics for ten days, or until the surgical wound heals completely. She may also recommend the VBeam laser to treat residual redness or scarring.

Frequently Asked Questions (FAQs)about Sebaceous Cysts

What Do Sebaceous Cysts Look Like?

Sebaceous cysts typically appear as small, round, flesh-colored or yellowish bumps beneath the skin, resembling a fluid-filled lump or a large pimple. The overlying skin may show a small central opening, and the cyst can range from the size of a pea to several centimeters in diameter.

Are Sebaceous Cysts Hard?

Sebaceous cysts often start as soft, mobile lumps under the skin but tend to become firmer over time as keratin accumulates within the cyst wall. A cyst that suddenly feels very hard, is fixed in place, or is rapidly changing in size should be evaluated by a dermatologist.

Do Sebaceous Cysts Grow?

Yes, sebaceous cysts can grow slowly over weeks, months, or even years, though some enlarge more rapidly if additional sebum, keratin, or debris becomes trapped inside. If cysts grow quickly or become painful, Dr. Green should evaluate them to rule out infection.

How Do Sebaceous Cysts Form?

Sebaceous cysts form when a hair follicle or pore becomes blocked by a buildup of sebum, keratin, and dead skin cells, allowing material to accumulate beneath the skin’s surface in a protective sac. This can happen because of clogged pores, acne, or trauma to a sebaceous gland.

Are Sebaceous Cysts Painful?

Sebaceous cysts are often painless when they first develop, but they can become tender or painful as they enlarge or if they become infected or inflamed. Any cyst that is warm, red, or increasingly uncomfortable should be evaluated promptly.

Are Sebaceous Cysts Contagious?

Sebaceous cysts are not contagious and cannot be spread through skin-to-skin contact. They form when a hair follicle or pore becomes blocked, not through infection. However, the fluid inside an infected cyst can contain bacteria that require treatment.

Are Sebaceous Cysts Dangerous?

Most sebaceous cysts are benign and not dangerous, though they can become uncomfortable, infected, or cosmetically bothersome if left untreated. In rare cases, a cyst that is unusually large, rapidly growing, or recurrent in the same location should be further evaluated to rule out a more serious skin condition.

Can Sebaceous Cysts Be Cancerous?

While most sebaceous cysts are noncancerous, malignancy cannot be ruled out entirely. A cyst larger than five centimeters in diameter, or one that recurs in the same location despite treatment, warrants further evaluation, which may include a biopsy.

How Long Do Sebaceous Cysts Last?

Small, asymptomatic sebaceous cysts can persist for months or years without causing problems and may eventually resolve on their own. Larger or symptomatic cysts, however, often require treatment by a dermatologist to fully resolve.

Do Sebaceous Cysts Go Away on Their Own?

Some small sebaceous cysts can shrink or resolve without intervention, particularly if the body gradually reabsorbs the trapped material. However, many cysts persist or continue to enlarge over time, and painful, infected, or cosmetically concerning cysts typically require treatment to resolve fully.

Can Sebaceous Cysts Burst?

Yes, a sebaceous cyst can rupture, either spontaneously or due to trauma or squeezing, releasing its contents into the surrounding tissue. A ruptured cyst is more likely to become infected or inflamed, so see a dermatologist rather than trying to pop or drain a cyst at home.

How Do Sebaceous Cysts Get Infected?

When bacteria enter a sebaceous cyst, whether through a break in the overlying skin, a ruptured cyst wall, or repeated irritation, an infection can develop. Infected cysts typically become red, warm, tender, and swollen, and may drain foul-smelling pus, requiring antibiotics and often in-office drainage.

Do Sebaceous Cysts Come Back?

If any part of the cyst wall remains after removal, a sebaceous cyst can recur in the same location. Complete removal of the cyst wall, using a technique such as conventional wide excision, offers the best chance of preventing recurrence.

Why Do I Keep Getting Sebaceous Cysts?

Some patients are more likely to develop multiple sebaceous cysts due to genetics, hormonal factors, oily skin, or an underlying condition such as steatocystoma multiplex or Gardner syndrome. Dr. Green can help identify any underlying cause and recommend a treatment and skin care plan to reduce the frequency of new cysts.

How to Prevent Sebaceous Cysts?

While you can’t prevent all sebaceous cysts, keeping your skin clean, exfoliating regularly, and treating acne promptly can help reduce the buildup of sebum, keratin, and dead skin cells that clog hair follicles and pores. Avoiding skin trauma and addressing any underlying skin condition with Dr. Green can also help lower the risk of developing new cysts.

What Kind of Doctor Removes Sebaceous Cysts?

A board-certified dermatologist, such as Dr. Michele Green, is trained to diagnose and remove sebaceous cysts using techniques that minimize scarring and reduce recurrence risk. In some cases, particularly with larger cysts on the face, a plastic surgeon may also be involved.

How Do Doctors Remove Sebaceous Cysts?

Dermatologists remove sebaceous cysts using techniques such as incision and drainage, minimal excision, or conventional wide excision, depending on the cyst’s size, location, and whether it is infected. During an in-office evaluation, Dr. Green determines the most appropriate technique for each patient to achieve the best cosmetic and medical outcome.

How to Get Rid of Sebaceous Cysts?

The most effective and reliable way to get rid of a sebaceous cyst is to have a board-certified dermatologist evaluate it and surgically remove it. Removal techniques range from minimal excision to conventional wide excision, both of which are designed to remove the cyst wall and help prevent recurrence.

Should You Squeeze Out a Sebaceous Cyst?

You should not attempt to squeeze out a sebaceous cyst on your own, as this can traumatize the cyst and increase the risk of infection and scarring. If you have pain or discharge, consult a dermatologist.

How Can I Get Rid of a Cyst at Home?

You can apply a warm compress made with sterile water to a sebaceous cyst, but avoid boiling-hot water to prevent burns. Leaving the warm compress on the affected area several times a day, along with an over-the-counter antibiotic ointment or benzoyl peroxide, may help reduce inflammation. However, it will not remove the cyst itself.

Can I Stick a Needle in a Sebaceous Cyst?

Some patients attempt to sterilize a needle and puncture the cyst at home; however, it is unlikely that all of the cyst contents and the cyst wall will be removed this way, and doing so can irritate the area and increase the risk of infection.

How Do You Remove a Sebaceous Cyst at Home?

It is not advisable to remove a sebaceous cyst at home, as it can lead to scarring and infection. Without specialized medical tools, it is nearly impossible to remove the cyst wall completely, leaving the area irritated and prone to infection, recurrence, and further scarring.

What Can Happen if a Cyst Is Left Untreated?

A small, asymptomatic sebaceous cyst does not necessarily need treatment. However, a cyst that is large, painful, or cosmetically unsightly should be evaluated by a dermatologist, as untreated cysts can enlarge, become infected, and lead to further scarring.

Schedule Your Sebaceous Cyst Consultation with Dr. Michele Green Today

Sebaceous cysts, along with related growths such as epidermoid and pilar cysts, are common, benign skin conditions that can affect the face, neck, scalp, upper back, and other areas of the body. While many of these cysts are harmless and painless, they can grow, become infected, or cause cosmetic concerns if left untreated, making accurate diagnosis and proper treatment essential. From identifying the cyst type to determining the safest removal technique, Dr. Michele Green provides expert, individualized care for patients with sebaceous cysts in her NYC office.

Dr. Michele Green is an internationally recognized, board-certified dermatologist with over 25 years of experience, providing some of New York City’s most discerning men and women with expert, minimally invasive treatments for sebaceous cysts and other skin conditions. Castle Connolly, New York Magazine, Super Doctors, and The New York Times consistently name Dr. Green among NYC’s top dermatologists for her commitment to her patients and her expertise. To learn more about treating your sebaceous cyst, contact us online today or call Dr. Green’s NYC office at 212-535-3088.