Optimal Timing for Surgery on Epidermoid Cysts: A Dermatologist's Guide

Timing for Surgery of Sebaceous Cysts

Hello, Doctor: I have developed multiple sebaceous cysts on my buttocks and thighs over the past six years, with the number exceeding ten.
When inflamed, their size ranges from 1 to 10 centimeters.
Previously, I consulted a dermatologist who prescribed antibiotics and injections, but later the dermatologist stated that the medication was no longer effective in reducing the swelling, so they resorted to aspiration.
I initially hoped that traditional Chinese medicine would improve my condition, but it seems ineffective and only delays inflammation.
I have attempted to seek surgical removal several times but have been refused for the following reasons: 1.
The cysts are epidermoid cysts, and the main approach should be to improve cleanliness and ventilation; it is impossible to remove all hair follicles from the skin.
2.
Surgery cannot be performed while inflamed, or even if there is no pain, the cysts have not hardened yet.
3.
Aspiration has been performed.
4.
Drainage has been done.
Therefore, I would like to ask: 1.
What is the best timing for surgery, and how can it be determined? 2.
Are drainage and aspiration both more likely to recur, and is surgery the only option for a potential cure? 3.
Given the excessive number and the presence of nearly all black lesions, should treatment be done in stages? 4.
There are two cysts nearby that the dermatologist mentioned have formed a sinus tract; does this increase the difficulty of healing? 5.
If inflamed, should debridement be performed first, and how long does this treatment typically take, or can aspiration be done (I feel debridement is more painful)? How long should I wait before considering surgical removal again?

An An, 30~39 year old female. Ask Date: 2016/03/29

Dr. Wu Yuxin reply Dermatology

1.
Once the inflammation improves and the pain subsides, you can prepare for surgery.

2.
That's correct.

3.
It is recommended to perform the procedure in stages, with about two teeth per surgery being more appropriate.

4.
The incision area will be larger based on the extent of the tissue removal.

5.
Debridement is more effective than aspiration; once the inflammation improves and the pain subsides, you can prepare for surgery.

Reply Date: 2016/03/29

More Info

When it comes to epidermoid cysts, also known as sebaceous cysts, understanding the optimal timing for surgery and the management of these lesions is crucial for effective treatment. Based on your detailed history and the questions you've posed, let's break down the key points regarding the diagnosis, treatment options, and considerations for surgical intervention.

1. Understanding Epidermoid Cysts
Epidermoid cysts are benign, slow-growing lumps that can occur anywhere on the body, often arising from hair follicles. They are filled with keratin and can become inflamed or infected, leading to discomfort or pain. The fact that you've experienced multiple occurrences over six years suggests a predisposition to developing these cysts, which can be influenced by factors such as genetics, skin type, and hygiene practices.

2. Optimal Timing for Surgery
The best time to consider surgical intervention is when the cyst is not inflamed or infected. Surgery is typically recommended when:
- The cyst is symptomatic (causing pain or discomfort).

- The cyst is recurrent or has a history of inflammation.

- The cyst is large or growing in size.

In your case, it seems that your cysts have been inflamed multiple times, which complicates the decision for surgery. The general guideline is to wait until the cyst has resolved and is no longer tender or inflamed. This can take several weeks after an episode of inflammation. A good indicator for surgery is when the cyst is firm, non-tender, and has returned to its baseline size.

3. Drainage vs. Surgical Excision
While drainage or aspiration of the cyst can provide temporary relief, it often does not eliminate the cyst entirely. The cyst wall may remain, leading to recurrence. Surgical excision, on the other hand, involves removing the entire cyst and its wall, which significantly reduces the chance of recurrence. If you have multiple cysts, it may be advisable to address them in stages, especially if they are large or if you have concerns about the surgical site healing.

4. Considerations for Multiple Cysts
Given that you have over ten cysts, it may be practical to prioritize which cysts are most symptomatic or problematic. Your dermatologist or surgeon can help determine which cysts should be addressed first based on their size, location, and your symptoms.

5. Impact of Inflammation on Surgery
If a cyst is currently inflamed, it is generally advisable to wait until the inflammation subsides before proceeding with surgery. This is because operating on an inflamed cyst can increase the risk of complications, such as infection or poor healing. The duration for inflammation to resolve can vary, but it typically takes a few weeks. During this time, conservative management, such as warm compresses or anti-inflammatory medications, may be beneficial.

6. Healing and Recovery
Post-surgical recovery will depend on the size and location of the cysts being removed. Generally, patients can expect some swelling and tenderness at the surgical site, which usually resolves within a few days to weeks. Follow-up care is essential to monitor for any signs of infection or complications.

Conclusion
In summary, the optimal timing for surgery on epidermoid cysts is when they are asymptomatic and not inflamed. While drainage can provide temporary relief, surgical excision is the most effective way to prevent recurrence. Given the number of cysts you have, a staged approach may be necessary. Always consult with your dermatologist or a qualified surgeon to develop a tailored treatment plan that considers your specific circumstances and health history.

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