Management of Inflamed Draining Sebaceous Cysts

Primary Treatment Approach

• Incision and drainage is the recommended treatment for an inflamed sebaceous cyst that is draining, as it is the cornerstone of treatment for inflamed sebaceous cysts, particularly when they are draining 1, 2
• Gram stain and culture of pus from inflamed epidermoid cysts (sebaceous cysts) are not recommended as routine practice 1, 2, 3
• After drainage, simply covering the surgical site with a dry dressing is usually the easiest and most effective treatment of the wound 2
• Packing the wound with gauze is not recommended as one small study found it caused more pain and did not improve healing compared to just covering the incision site with sterile gauze 1, 2

Antibiotic Considerations

• Systemic antibiotics are usually unnecessary for inflamed sebaceous cysts unless there are signs of systemic infection, such as temperature >38°C or <36°C, tachypnea >24 breaths per minute, tachycardia >90 beats per minute, or white blood cell count >12,000 or <400 cells/µL 1, 2, 4, 5
• If antibiotics are deemed necessary, they should be active against Staphylococcus aureus, which is a common pathogen 1, 2

Special Considerations

• The inflammation in sebaceous cysts typically occurs as a reaction to rupture of the cyst wall and extrusion of its contents into the dermis, rather than as a primary infectious complication 3
• For recurrent sebaceous cysts at the same site, a search for local causes such as foreign material should be conducted 4, 5

Follow-up Care

• If recurrent infections occur at the same site, consider complete excision of the cyst and its wall once the acute inflammation has resolved 4, 5

Common Pitfalls to Avoid

• Avoid closing the wound without adequate drainage, as this may lead to recurrent infection 1, 2
• Do not routinely prescribe antibiotics unless there are signs of systemic infection or the patient has markedly impaired host defenses 1, 2, 5
• Avoid packing the wound unnecessarily as it may increase pain without improving healing outcomes 1, 2

Management of Incompletely Drained Infected Sebaceous Cysts

Understanding Infection and Drainage

• The infection may persist or worsen if the cyst contents are not thoroughly evacuated 6
• Effective treatment entails thorough evacuation of the pus and probing the cavity to break up loculations 6

Proper Management and Re-Drainage

• For inadequate drainage, consider re-opening the incision and ensuring complete evacuation of all contents 7
• Probing the cavity to break up any loculations or septations is necessary for complete drainage 6