Epidermoid Cyst: Causes, Diagnosis, Symptoms, Treatment, Risk Factors and Complications

It is a benign cyst consisting of small non-cancerous lumps usually found under the skin.

The cyst develops from ectodermal tissue. Histologically, it is made of a thin layer of squamous epithelium.

You can choose to have a cyst removed by a doctor if it bothers you or hurts, breaks, or is infected.

It is usually asymptomatic. However, it can become symptomatic due to a secondary infection or when it reaches dimensions that can cause damage to the surrounding anatomical structures.

It occurs in a wide range of ages, from birth to 72 years, and often occurs in people between 15 and 35 years. It can develop in any part of the body; It has slow growth and is rare. 7% of these cysts occur in the head and neck; the oral cavity represents only 1.6%.

These skin structures are represented by the hair, sebaceous glands, hair follicles, and sweat glands.

Epidermoid cysts are prevalent in men and originate in the hyperplasia of the infundibular epithelium in response to an inflammatory process in the hair follicle.


They can develop in an isolated or multifocal form, as seen in Gardner’s syndrome.

Epidermoid cysts of exacerbated sizes are easier to break, being more susceptible to secondary infection.

Another critical point is when these giant cysts develop in the head and neck region. Due to the high visibility of these regions, the patient may experience depression and anxiety caused by the aesthetic appearance of the lesion.

A combination of factors may be responsible for developing an epidermoid cyst, traumatism, epithelial proliferation, or minimal inflammation.

It is difficult to predict that these factors may occur concomitantly, which could explain the rarity of these cases. Since epidermoid cysts are generally asymptomatic and slow-growing, the patient usually can not associate the lesion with a possible trauma.

Terminology of an epidermoid cyst

There are several synonyms for epidermal cysts, including epidermal cyst, infundibular cyst, keratin cyst, and epidermal inclusion cyst.

The inclusion of epidermal cyst refers more specifically to the implantation of epidermal elements in the dermis.

The term infundibular cyst refers to the site of origin of the cyst: the infundibular portion of the hair follicle. Most epidermal inclusion cysts originate in the infundibular part of the hair follicle, which explains the interchangeable but inaccurate use of these two terms.

Another cyst similar and easily confused is the sebaceous cyst.

Signs and symptoms

The signs and symptoms of the epidermoid cyst include:

  • There is a small round lump under the skin, usually on the face, neck, or trunk.
  • A small pimple is clogging the central opening of the cyst.
  • A thick, yellow, malodorous material that sometimes drains from the cyst.
  • If it is inflamed or infected, there is redness, swelling, and tenderness in the area.


Epidermoid cysts are usually the result of the implantation of the epidermis in the dermis, as in trauma or surgery. They can also be caused by a blocked pore adjacent to a body piercing.

They are also observed in Gardner syndrome and the Nevoid basal cell carcinoma syndrome in the head and neck. They can be infected by bacteria and form a grain shape.

Diagnosis of an epidermoid cyst

Epidermoid cysts are usually diagnosed when a person notices a lump on their skin and seeks medical attention.

The definitive diagnosis is made after the excision performed by a pathologist based on the microscopic appearance of a cystic lesion covered by cornified epithelium containing lamellated keratin without calcifications.

They can also be seen as isointense lesions in magnetic resonance or hyperintensities in the recovery of inversion attenuated by fluids.


You can leave a cyst only if it does not cause discomfort or aesthetic problems. If you are looking for treatment, talk to your doctor about these options:

Injection: this treatment involves injecting the cyst with a medication that reduces swelling and inflammation.

Incision and drainage: with this method, your doctor makes a small cut in the cyst and gently squeezes the contents. This is a relatively easy and quick method, but cysts are often repeated after this treatment.

Minor surgery: your doctor can remove the entire cyst. You may need to return to the doctor’s office to have your stitches removed. The minor surgery is safe and effective and generally prevents cysts from reappearing. If your cyst is inflamed, your doctor may delay the surgery.

In the case of fronto-ethmoidal epidermoid cysts, surgical resection seems to be the basis of treatment; however, the extension of the resection is dictated by the adherence of the tumor capsule to the surrounding vital structures.

Hydrogen peroxide gel (H2O2) was previously recommended to treat cysts, particularly those in body piercings.

However, the gel can not adequately penetrate the cyst and was not found to be effective. Doctors no longer recommend hydrogen peroxide for wound care, as it can damage healing tissues.

In body piercings, self-treatment with a warm saline solution to help drain the cyst and an antibacterial or medicated talcum (the use of talc is no longer recommended due to recently discovered associations with multiple cancers).

It is usually recommended to help dry the lump and reduce bacterial growth until medical advice can be obtained.

The piercings in the cheeks seem to be the most prone to cysts due to the possible interruption of the salivary ducts.

Lifestyle and home remedies:

It can not stop the formation of epidermoid cysts. But it can help prevent scars and infections by:

  • Do not squeeze the cyst yourself.
  • Placing a warm, moist cloth over the area to help the cyst drain and heal.

Risk factor’s

Almost anyone can develop one or more epidermoid cysts, but these factors make it more susceptible:

  • Having passed puberty.
  • Have certain rare genetic disorders.
  • To hurt the skin.


Potential complications of epidermoid cysts include:

The rupture of a cyst often leads to an infection similar to boiling that requires immediate treatment.

When to see a doctor?

Most epidermoid cysts do not cause problems or need treatment. Consult your doctor if you have one or more:

  • It proliferates.
  • Ruptures or becomes painful or infected.
  • It happens in a place constantly irritated.
  • It bothers you for aesthetic reasons.
  • It is located in an unusual location, such as a finger and toe.

You will probably visit your primary care doctor first. They will diagnose your condition and describe the treatment for your cyst.

Options may include observation, incision, drainage if inflamed or infected, and extraction. Occasionally, you may be referred to a doctor specializing in skin disorders (dermatologist).

Here is some information that will help you prepare for your appointment:

What you can do:

List your critical medical information, such as the conditions you have been treated for and the medications, vitamins, and supplements you take.

Consider recent skin lesions, including surgical incisions and accidental injuries.

Make a list of questions you have about your condition.

Here are some basic questions to ask your doctor about epidermal cysts. If you have any additional questions during your visit, do not hesitate to ask:

  • What causes this type of cyst?
  • What treatment do you recommend, if any?
  • Will I have a scar after the treatment?
  • Am I at risk of this condition happening again?
  • Can I do something to help prevent a recurrence?
  • Do epidermoid cysts increase my risk of other health problems?
What to expect from your doctor:

Your doctor may ask you a series of questions, such as:

  • Have you noticed other skin growths?
  • Have you had similar changes in the past? If so, in what parts of your body?
  • Have you had severe acne?
  • Does the change cause any discomfort?
  • Are you embarrassed by the difference?
  • Have you had any recent skin lesions, including minor scratches?
  • Did you recently have a surgical procedure in the affected area?
  • Does anyone in your family have a history of acne or multiple cysts?
What can you do in the meantime:

Resist the temptation to try to squeeze or “pop” your cyst. Your doctor will be able to take care of the cyst with the least risk of scars and infections.