Tuesday 21 January 2020

Dear Dr Nina: Should I get rid of my cyst or will the scar left behind be worse?

The best way to deal with an unwanted cyst is for the cyst and capsule to be removed together
The best way to deal with an unwanted cyst is for the cyst and capsule to be removed together

Nina Byrnes

I have a sebaceous cyst in the centre of my chest, just below my collar bone. I have had it for about five years and although it hasn't got any bigger, it hasn't gone away either. It got infected a few years ago when I tried to squeeze the contents out. I am really self conscious about it and I was wondering what my options are in having it removed. I enquired with a beautician a few years ago and she said that it may leave a bigger scar than the cyst and also, that it may come back even after removal. I've tried tea-tree oil and various creams and oils, which reduce it slightly, but only for a day or two. Do I have to have surgery to remove it?

Dr Nina replies: Skin has two main layers. Our bodies are also covered in a tough protective layer of protein (called keratin), and fine hair. The root of these hairs lies in the deeper layer of skin and they are supplied with oil, called sebum, by small glands called sebaceous glands.

In normal skin, sebum is produced and moves along the hair to the surface of the skin. The sebaceous glands can become blocked by plugs of keratin and sebum. This initially leads to a small spot, which is white if it is below the skin surface. If it comes to the surface, the pigment turns black, creating blackheads.

As the sebaceous glands become increasingly congested, there is local inflammation in the deeper layer of skin, which causes a red bump to appear on the skin called a 'papule'. Local bacteria, which normally live on the skin, can invade this. The inflammation and infection leads to the development of pus. This causes the papule to rise to the surface, causing the common spot or pimple. These are acne spots.

Lumps that seem to appear under the skin are often referred to as sebaceous cysts, but this can be a misnomer, as the majority of these are either 'epidermoid' or 'pilar' cysts.

Epidermoid cysts form from the cells that normally produce the outer layer of skin, and pilar cysts form in the base of a hair follicle. There can be a familial tendency towards these, but most occur for no particular reason. It has been suggested that damage to the skin may be a risk, but no conclusive link has been found

Both these cysts can form smooth lumps varying in size from that of a small pea to ones several centimetres in diameter. Cysts often have a small dot or punctum on the surface. This spot like appearance may make them tempting to squeeze. If you squeeze them, they extrude a toothpaste-like substance that often smells quite cheesy. This substance is 'boggy keratin', which normally is one of the building blocks of hair and skin cells.

Although the size may be alarming, epidermoid and pilar cysts are benign lumps and no treatment is required unless they are causing pain or are cosmetically undesirable.

Cosmetic procedures, such as laser, have been tried with mixed benefits. Creams and potions may help reduce inflammation and treat an infected cyst but will not get rid of the cyst itself. Squeezing them may release the keratin filling, but the capsule remains and so these can refill. Pressing and squeezing on a cyst may ultimately cause an infection. Infected cysts can become red, swollen and painful A course of antibiotics is required to treat the infection before a more definitive solution can be found.

The best way to deal with an unwanted cyst is for the cyst and capsule to be removed together. This is a straightforward procedure that is done under local anaesthetic. Some GPs undertake this kind of work, otherwise it is considered a day case hospital procedure. There are very few, if any, complications. Depending on the size of the cyst, some stitches may be required. There is usually a small scar left behind which will be permanent. Occasionally, a cyst may reoccur at the same location. If this happens, it can be removed again.

What is the best way to allow a cut to heal — by covering it with a plaster or by exposing it to the air ?

Dr Nina replies: Wound healing is a complex process. The damaged tissue needs to pass through several stages to heal fully. The damaged skin layers bring inflammation, which forms a healing surface, clears damaged and dead cells and then allows new cells to grow regenerate and ultimately heal.

The time that it takes for this to occur will depend on how severe the wound is, its location and the health of the individual affected. Conditions, such as vascular disease, diabetes, infection or those with older or damaged skin, may find healing takes longer to occur.

When a wound is bleeding, applying a dressing is the norm. This is usually done to kerb blood flow, but dressings can also have a healing role. There are many studies that show that wounds heal faster when they are kept moist. Skin regenerates more efficiently and scarring may be less severe.

Most surgical dressings will have a non-adherent surface and various gauzes and colloidal compounds are used by dressing teams to improve healing.

The best way to reproduce this at home is to clean the wound and apply a small amount of petroleum jelly over it. This creates a barrier, keeping dirt out and moisture in. Depending on the size and location of the wound, a non-stick dressing, such as a plaster, may be applied over this.

Keeping a wound moist does not just mean applying a plaster and leaving it there. Changing a dressing and ensuring the wound is clean and germ-free is important. Wounds on areas that get wet often, such as on the hand, may need to be dressed more than once a day.

Moist skin is healthy and pink. Wounds that become infected may have a slight dusky colour and cloudy ooze. We refer to this as boggy skin and this may be infected.

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