Sebaceous Cysts: Symptoms, Growth, and Concerns

Regarding a lump on the buttocks?

Yesterday, I took a picture (https://imgur.com/a/NAuUqkS).
About a month ago, I noticed a hard lump near the lower left side of my buttocks, close to my thigh.
I discovered it because it hurts when I sit down.
Upon taking a photo, I saw that there was no opening, and when I touched it, it felt hard, but the center felt soft.
If I squeeze the soft, yellowish center, it bulges out.
I didn't see a doctor during this time, and since sitting on it caused pain (I was enduring the pain), I finally went to a surgeon last week because the pain intensified and the lump grew larger.
After the doctor examined it, he said it was a sebaceous cyst (lipoma).
I overheard the doctor and nurse mention "4x3" and was prescribed antibiotics and anti-inflammatory medication.
I have a few questions for the doctor:
1.
Will the lipoma always feel hard? I've heard that they are usually soft, so why does mine feel so hard (could it be due to irritation from sitting on it)? Is this a sign of malignancy?
2.
Can a lipoma grow significantly in a short time, like a month? Initially, it was about 1.5 to 2 centimeters, but now it feels about 4 centimeters.
Aren't lipomas supposed to grow slowly over several years? Given the first point, I'm very concerned that it might be something serious.

3.
In the picture, the center, which is about the size of a coin, feels soft and does not hurt when pressed.
The surrounding area feels very hard, and a few days ago, it was painful.
Is it normal for the center to be soft while the surrounding area is hard? The center was soft and yellowish, but now it has turned dark purple and remains soft.
Is this normal?
I understand that the doctor cannot provide a definitive diagnosis online, but I will be returning to the hospital for follow-up.
I just wanted to seek your guidance to address my concerns.
Thank you very much for your response.

K, 20~29 year old female. Ask Date: 2021/04/22

Dr. Chen Jiaming reply Surgery

1.
Sebaceous cysts can be either soft or hard, and the subjective sensation varies from person to person, with no standard.
Your condition may have become inflamed, causing the soft tissue to swell and harden.
This is not related to malignancy.
2.
A lipoma is an accumulation of sebaceous gland contents, and the rate of enlargement varies among individuals; noticeable growth may also be influenced by inflammatory swelling.
3.
The color and appearance are not the main focus of inflammation treatment.
Generally, antibiotics are used to treat inflamed lipomas, and if effective, they will gradually become less painful.
However, some individuals may have a higher bacterial load, leading to the formation of an abscess that requires incision and drainage.
It is advisable to have regular follow-up appointments and to avoid excessive irritation of the local mass during the process.

Reply Date: 2021/04/22

More Info

Sebaceous cysts, also known as epidermoid cysts or pilar cysts, are common benign growths that can occur anywhere on the body, including the buttocks and thighs. They are typically filled with a thick, yellowish substance called keratin, which is a protein found in skin cells. Understanding the characteristics, growth patterns, and concerns associated with sebaceous cysts can help alleviate anxiety and guide appropriate management.

1. Consistency and Hardness: Sebaceous cysts can vary in consistency. While many are soft and movable, they can feel firm or hard, especially if they become inflamed or infected. The hardness you are experiencing may be due to inflammation caused by pressure from sitting or irritation. When a cyst becomes inflamed, the surrounding tissue can swell, making it feel firmer. It is important to note that sebaceous cysts are benign and typically do not become malignant. However, any sudden changes in size or consistency should be evaluated by a healthcare professional.

2. Growth Rate: Sebaceous cysts generally grow slowly over time, often taking years to reach a noticeable size. However, they can sometimes grow more rapidly, especially if they become inflamed or infected. The increase in size from 1.5-2 cm to approximately 4 cm in a month is concerning and warrants further evaluation. Rapid growth can sometimes indicate complications such as infection or the formation of an abscess, which may require medical intervention.

3. Symptoms and Changes: The symptoms you describe, such as pain and changes in color, are significant. A sebaceous cyst may become painful if it is inflamed or infected, leading to redness, warmth, and tenderness. The presence of a soft, yellowish center that becomes dark purple could indicate that the cyst is either rupturing or has developed an infection. It is crucial to monitor these changes closely. If the cyst becomes increasingly painful, red, or shows signs of drainage, it is essential to seek medical attention promptly.

4. Management and Treatment: Treatment for sebaceous cysts often depends on the symptoms and the presence of infection. If the cyst is not causing significant discomfort or complications, it may be left untreated. However, if it becomes painful, infected, or bothersome, options include:
- Antibiotics: As prescribed by your doctor, antibiotics can help manage any infection associated with the cyst.

- Incision and Drainage: If the cyst is infected or causing significant discomfort, a healthcare provider may recommend draining it. This procedure involves making a small incision to allow the contents to escape.

- Surgical Removal: For recurrent or bothersome cysts, complete surgical excision may be necessary to prevent recurrence.

5. When to Seek Help: It is advisable to follow up with your healthcare provider, especially given the changes you have observed. If you notice any signs of systemic infection (such as fever), increased pain, or if the cyst continues to grow, seek medical attention immediately.
In conclusion, while sebaceous cysts are generally benign, any significant changes in size, consistency, or associated symptoms should be evaluated by a healthcare professional. Your concerns are valid, and it is wise to seek further medical advice to ensure appropriate management and peace of mind.

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