Pilar cysts (trichilemmal cysts) are small, flesh-colored bumps that form beneath the skin, primarily on the scalp. These growths originate from the hair follicle and are filled with keratin, the protein that makes up hair and nails. They are common, affecting about 10% of the population, and are non-cancerous. While generally harmless, preventative scalp care can help manage their occurrence.
What Causes Pilar Cysts
Pilar cysts form when the hair follicle’s outer root sheath multiplies inward, creating a sac that fills with keratin. This protein accumulation creates the characteristic firm, smooth lump beneath the skin. Unlike epidermoid cysts, pilar cysts have a distinct wall resembling the lining of the hair root.
The development of these cysts is strongly linked to genetics, following an autosomal dominant inheritance pattern. If one parent has the condition, their child has a 50% likelihood of inheriting the predisposition. Since the underlying cause is genetic, lifestyle changes cannot offer absolute prevention, but they can minimize external factors that might aggravate cyst formation. The condition is seen more frequently in middle-aged women, though it can affect anyone with the genetic susceptibility.
Actionable Steps for Scalp Health
Maintaining optimal scalp health can mitigate irritation and inflammation, potentially reducing the risk of developing new cysts. A gentle hair care regimen protects susceptible hair follicles by avoiding products containing harsh detergents that strip the scalp’s natural protective oils, which may lead to irritation or dryness.
Look for sulfate-free shampoos and conditioners, avoiding ingredients like Sodium Lauryl Sulfate (SLS) and Sodium Laureth Sulfate (SLES). Strong fragrances and formaldehyde-releasing preservatives, such as DMDM Hydantoin, should be avoided as they are common irritants that compromise the scalp barrier. Gentle cleansing prevents inflammation, which could encourage follicular disruption.
Managing physical stress on the scalp is beneficial for those genetically predisposed to pilar cysts. Avoid excessive friction from tight hairstyles (braids or severe ponytails) and minimize abrasive styling tools or intense heat. A light, regular scalp exfoliation may help prevent the buildup of dead skin cells that contribute to follicular blockage. Additionally, a diet rich in antioxidants, Omega-3 fatty acids, and Vitamin A supports overall skin health.
Monitoring and Preventing Recurrence
Once a pilar cyst has formed, monitoring its condition is important, as professional intervention is required for elimination. Although typically painless, any change in an existing cyst—such as rapid growth, sudden pain, redness, or warmth—warrants medical attention. These symptoms indicate the cyst has become inflamed or infected.
Professional treatment, usually surgical excision, is the only reliable method for preventing recurrence. This procedure involves removing the entire cyst sac or wall, because fragments left behind can regenerate a new cyst. Incomplete removal, such as simple draining, leads to a significantly higher rate of recurrence. Following removal, meticulous post-operative care, including keeping the site clean and adhering to wound care instructions, is necessary for optimal healing.