A “wen” is a general, non-medical term for various benign lumps or cysts that form just under the skin. It is a colloquial descriptor, not a formal medical diagnosis. This article clarifies what these lumps are, why they form, and what steps to take if one develops.
Understanding Common Wens
The term “wen” most commonly refers to two types of benign cysts: epidermoid cysts and pilar cysts. Epidermoid cysts, also known as epidermal inclusion cysts, are the most frequent type of skin cyst. They originate from epidermal cells that become trapped beneath the skin’s surface. These cysts often appear on the face, neck, and trunk, and can vary in size from a small pea to several centimeters. They are typically slow-growing, movable, and may be skin-colored or yellowish, sometimes presenting with a small dark punctum or opening.
Pilar cysts, also called trichilemmal cysts, are another common type of “wen” and primarily develop from the outer root sheath of a hair follicle. Approximately 90% of pilar cysts occur on the scalp, though they can also appear on the face, neck, and limbs. They feel like smooth, firm, mobile, flesh-colored nodules under the skin. Unlike epidermoid cysts, pilar cysts do not have a central punctum. These cysts are also slow-growing and can range in size.
What Causes Wens to Form?
Epidermoid cysts primarily form when surface skin cells, which normally shed, move deeper into the skin’s layers. These trapped cells multiply and form a cyst wall, secreting keratin. This accumulation of keratin, often described as a thick, cheesy substance, fills the cyst. While many epidermoid cysts appear spontaneously, they can also result from skin injury or irritation, or from blocked hair follicles.
Pilar cysts develop when old skin cells and keratin accumulate under the skin’s surface, specifically originating from the hair follicle’s outer root sheath. The keratin forms a thick, paste-like material within the cyst. These cysts can have a genetic component, as they may run in families, suggesting a predisposition to their formation. Both cyst types result from blockages within skin structures, leading to cellular debris buildup.
Recognizing a Wen and When to Be Concerned
A “wen” presents as a smooth, round or dome-shaped lump located just beneath the skin. These growths are flesh-colored or yellowish and can be moved freely under the skin’s surface. They tend to grow slowly and are painless unless they become inflamed or infected.
Seek medical advice if a lump exhibits concerning characteristics. Signs warranting evaluation include rapid growth, new pain, redness, or warmth around the lump. Other features include discharge, a foul odor, or if the lump feels hard and fixed rather than movable. These symptoms could indicate an infection, rupture, or a different type of growth requiring professional diagnosis.
Management and Removal Options
Many wens are benign and asymptomatic, requiring no treatment. If a cyst is small, painless, and not causing discomfort, a healthcare provider may recommend a watchful waiting approach. However, if a cyst becomes inflamed, painful, or infected, initial management may involve an incision and drainage procedure. During this procedure, a small cut is made to release accumulated fluid or pus, which can alleviate pain and swelling. While drainage provides immediate relief, the cyst wall often remains, meaning the cyst may recur.
For complete and lasting removal, surgical excision is performed. This procedure involves removing the entire cyst, including its wall, to prevent recurrence. Surgical excision is done under local anesthesia in an outpatient setting. Reasons for opting for surgical removal include cosmetic concerns, discomfort due to size or location, or recurrent infections.