Pilar cysts, also known as trichilemmal cysts or wens, are benign, skin-colored lumps that typically form on the scalp. These cysts arise from the outer hair root sheath, accumulating keratin, a protein that constitutes hair and nails. While generally harmless, they can become a cosmetic concern or cause discomfort if they grow large or become irritated. Occasionally, they may rupture, leading to pain or inflammation, which prompts individuals to seek professional removal.
Professional Removal Options
Surgical excision is the most effective method for removing a pilar cyst. This outpatient procedure involves the medical professional numbing the area with a local anesthetic. A small incision is then made directly over the cyst. The entire cyst, including its sac, is carefully removed to prevent recurrence. The incision is closed with sutures or adhesive tape, and most procedures take less than 30 minutes.
For smaller cysts, a minimal excision technique may be employed. This involves making a smaller incision, often around 2-3 mm, to extract the cyst contents and then the cyst wall. This method aims to reduce scarring while still ensuring the removal of the cyst sac. The goal remains complete removal of the cyst lining for a lasting solution.
A punch biopsy excision is another method for removing smaller pilar cysts, particularly those larger than a pea that have a thick enough wall. In this technique, a circular punch tool is used to create a small opening, 3-4 mm in diameter, to access the cyst cavity. The contents of the cyst are then emptied, and the thick cyst wall can be grasped with forceps and carefully pulled out through the small incision. This method often results in a smaller scar compared to traditional excision, but it may not be suitable for very large cysts or those with thin walls, as fragmentation of the cyst wall could increase the likelihood of recurrence.
Common Misconceptions About Removal
Attempting to squeeze or pop a pilar cyst at home is not recommended and can lead to complications. The cyst sac, which is the source of the keratin buildup, remains intact even if some contents are expelled, meaning the cyst is likely to refill. Furthermore, self-manipulation can introduce bacteria, leading to infection, inflammation, pain, or permanent scarring. If a cyst ruptures on its own, it can cause pain, swelling, and a thick, white or yellow discharge, indicating a need for professional medical attention.
Home remedies, such as applying essential oils or warm compresses, may offer temporary relief from inflammation or discomfort. For instance, tea tree oil and aloe vera possess anti-inflammatory and antimicrobial properties that might help soothe the area. A warm compress can promote drainage and lessen inflammation. However, these methods do not address the underlying cyst sac and will not remove the cyst itself; the cyst will likely persist or regrow.
While pilar cysts are benign and may not cause symptoms, leaving a bothersome cyst untreated when causing discomfort or growing larger is not always the best approach. Pilar cysts do not disappear on their own and can continue to grow, potentially becoming more noticeable or interfering with daily activities. If a cyst is causing pain, tenderness, or is a cosmetic concern, professional removal is an option to consider for long-term relief and to prevent potential complications like infection.
When to Consult a Doctor
Consult a healthcare professional if a pilar cyst shows signs of infection. These signs include redness, increased pain, swelling, warmth around the lump, or the discharge of pus or thick, yellow fluid. An infection can progress and may require oral antibiotics to reduce inflammation, though antibiotics do not remove the cyst itself.
Also consult a doctor if you notice any rapid growth or change in the cyst’s size, shape, or texture. While pilar cysts are slow-growing and benign, a quick change in appearance could warrant further investigation to rule out other conditions.
If the cyst is causing pain, tenderness, or discomfort, especially if it interferes with daily activities like brushing your hair, a doctor’s consultation can help determine appropriate management. Many individuals choose to have them removed for cosmetic reasons, even if the cyst is not painful. Consulting a doctor is also important if you have a new lump or are uncertain about the nature of any skin growth.