Pilar cysts, also known as trichilemmal cysts, are common growths originating from hair follicles, with over 90% appearing on the scalp. They usually present as smooth, skin-colored, firm lumps that can be moved slightly beneath the skin. These cysts form when old skin cells and keratin accumulate and become trapped under the skin’s surface, creating an encapsulated sac filled with this protein.
Do Pilar Cysts Resolve Naturally?
Pilar cysts generally do not resolve naturally. Their persistence stems from their encapsulated structure, filled with keratin. Unlike some other skin conditions, the body does not typically absorb this protein-filled sac. While very small cysts might slowly shrink, they often persist and can grow larger over time.
The cyst sac remains intact even if contents drain. If only the contents are drained without removing the entire sac, the cyst is highly likely to recur as cells continue to produce keratin. Pilar cysts are almost always benign, meaning they are non-cancerous. However, their persistent nature means they typically do not vanish without medical intervention.
When to Consider Removal
While pilar cysts are generally harmless, several reasons prompt their removal. Cosmetic concerns are a frequent motivation, especially for cysts located on the scalp that can be noticeable. Discomfort can also arise, as larger cysts may cause pain if they press on surrounding tissue or become irritated by brushing hair.
Another significant factor is the risk of complications, such as rupture, inflammation, or infection. If a cyst ruptures, its contents can leak into surrounding tissue, leading to inflammation, pain, and potential infection. Rarely, a pilar cyst can transform into a proliferating trichilemmal tumor, which, though usually benign, may be locally aggressive and require removal. Seek medical attention if a cyst becomes painful, inflamed, or shows signs of infection like oozing.
Methods for Removal
The most effective method for pilar cyst removal is surgical excision. This outpatient procedure typically involves numbing the area with a local anesthetic. A small incision is made directly over the cyst, allowing the surgeon to carefully remove the entire cyst, including its sac. Removing the complete sac is crucial to minimize the chance of the cyst recurring.
After the cyst and its sac are removed, the incision is closed, often with sutures or skin adhesive. Post-procedure care is important for proper healing and involves keeping the surgical site clean and dry for the first 24 to 48 hours. Patients should avoid touching or scratching the treated area and use any prescribed antibiotic ointments to prevent infection. Mild discomfort, swelling, or bruising might occur, usually subsiding within a few days, and strenuous activities should be limited for one to two weeks to aid healing.