Are Epidermoid Cysts Painful?

Epidermoid cysts, also known as sebaceous cysts, are common noncancerous lumps that develop underneath the skin. An epidermoid cyst forms when keratin, a protein found in the outer layer of skin, accumulates within a hair follicle or oil gland. The cyst grows over time as more keratin is produced and can range in size from a few millimeters to several centimeters across.

Although epidermoid cysts are typically slow-growing and often painless, some cases can become inflamed, infected, or irritated leading to pain and other bothersome symptoms. So are epidermoid cysts actually painful?

What Causes Epidermoid Cysts to Become Painful?

In many instances, epidermoid cysts do not cause any pain or discomfort. The cysts form gradually under the skin surface and are harmless growths filled with the protein keratin and other skin cell debris.

However, epidermoid cysts can become tender, inflamed, or even infected in some cases:

Irritation or friction: Cysts located in areas prone to friction or pressure from clothing, belts, or jewelry can become irritated and inflamed. The constant rubbing against the lump can make it tender and sore.
Rupture: If an epidermoid cyst ruptures, the keratin and fluid inside will spill out into the surrounding tissue. This can trigger pain, inflammation, and infection.
Infection: Bacteria can enter the cyst through an opening or pore, causing infection. Infected cysts are often red, swollen, warm, and tender to the touch.
Hormonal changes: Hormonal fluctuations during puberty, menstruation, or pregnancy may cause some epidermoid cysts to become painful and tender. The reason is unclear but may be related to changes in sebum production.
Rapid growth: Rapid enlargement of a cyst can stretch the overlying skin and place pressure on surrounding nerves, resulting in pain.
Medical conditions: Certain medical conditions like acne or pilonidal disease can lead to recurrent, painful epidermoid cysts on the face, neck, or buttocks region.

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Common Signs and Symptoms of Painful Epidermoid Cysts

Epidermoid cysts that become irritated, infected, or inflamed can produce noticeable signs and symptoms:

A visible lump or bump under the skin that appears swollen and/or red
Tenderness or pain when pressure is applied to the cyst
A burning or throbbing sensation around the cyst
Warmth and redness of the overlying skin, signaling inflammation
Fluid drainage from the cyst that may be blood-tinged or yellow/white with a foul odor
Fever, chills, fatigue and other flu-like symptoms if infection develops
Enlarged, tender lymph nodes near the cyst

In most cases, an inflamed epidermoid cyst will only cause localized pain directly over the lump itself. But in some instances, especially with rupture or infection, the pain can radiate to surrounding areas. Seeking prompt medical treatment is advised if an epidermoid cyst becomes painful or shows signs of inflammation.

When to See a Doctor for a Painful Epidermoid Cyst

Since the majority of epidermoid cysts are not painful, any new onset of tenderness, swelling or redness warrants medical evaluation. It is advisable to consult a doctor or dermatologist if an epidermoid cyst becomes painful or shows other worrisome signs such as:

The cyst is rapidly enlarging or changing in appearance
Fever, chills, fatigue or flu-like symptoms develop
Redness, warmth and extreme tenderness over the cyst
Drainage of fluid, especially if foul-smelling
Severe pain that interferes with daily activities
Multiple painful cysts appear suddenly

Seeking timely treatment for an inflamed epidermoid cyst can help avoid complications like rupture, extensive scarring and dangerous bacterial infections. Healthcare providers may drain painful cysts through a small incision or surgically remove problematic cysts. Antibiotics may be prescribed if infection is present.

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Self-Care Tips for Painful Epidermoid Cysts at Home

Mildly painful epidermoid cysts can sometimes be managed conservatively at home using the following self-care techniques:

Apply a warm compress over the cyst 2-3 times per day to promote drainage and healing. Do not apply heat to severely inflamed or infected cysts.
Take over-the-counter pain relievers like acetaminophen, ibuprofen or naproxen to help reduce pain and inflammation.
Avoid irritating or squeezing the cyst as this can worsen symptoms. Leave the cyst alone if possible.
Wear loose-fitting clothing to prevent friction against painful cysts in the groin, underarms, or neck.
Apply an antibiotic ointment and bandage to cysts that have ruptured or drained to prevent infection.
Improve cyst symptoms by managing stress levels, getting adequate sleep, and eating a balanced, healthy diet.
For recurrent cysts, pay attention to potential triggers like shaving, hormonal changes, or friction from clothing or activity.

See a doctor promptly if self-care and OTC measures do not relieve pain within 2-3 days. Leaving an inflamed epidermoid cyst untreated can allow infections to worsen over time.

Medical Treatments for Painful Epidermoid Cysts

If self-care strategies are ineffective at controlling cyst discomfort, the following medical treatments may be recommended:

Drainage

A doctor can drain the contents of a painful epidermoid cyst using a small incision and sterile needle. Local anesthesia is generally injected to numb the area first. Draining the fluid and keratin removes pressure and inflammation, providing rapid pain relief. The cyst may refill with time however.

Oral Antibiotics

For infected cysts, doctors often prescribe oral antibiotics to treat the underlying bacterial infection. Antibiotics can help resolve pain, swelling, and other symptoms. Some common choices include cephalexin, dicloxacillin, clindamycin, or erythromycin. Applying antibiotic ointments to the cyst surface may also help.

Steroid Injections

Injecting a steroid medication directly into the inflamed cyst can help reduce local swelling, tenderness, and pain. The effects may only be temporary but steroid shots can offer relief for recurrent cyst inflammation.

Surgical Removal

Surgically removing problematic epidermoid cysts through excision can prevent recurrent pain and infection. Removal may be recommended for large cysts, cysts at risk of rupture, severely inflamed cysts not responding to other treatments, or cosmetically concerning cysts. Various surgical techniques are available, including traditional excision, punch biopsy excision, or minimal excision after cyst rupture.

Laser Therapy

Ablative laser or CO2 laser therapy can eliminate inflamed epidermoid cysts with minimal scarring. The laser vaporizes the cyst contents and wall through precision heating. This treatment requires local anesthesia but allows damaged tissue to heal faster with new collagen formation.

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Are Painful Epidermoid Cysts a Cause for Concern?

In most cases, simple self-care measures can relieve mild irritation and pain from epidermoid cysts. With proper treatment, even inflamed or infected cysts generally heal without complications.

However, medical evaluation is recommended if the cyst becomes extremely painful, continues growing, or shows signs of a severe infection. Rarely, an untreated infected cyst can develop into a serious bacterial skin infection called cellulitis.

Cysts that are located deeper in tissues or near sensitive structures may also require more prompt medical drainage or removal. Overall though, painful epidermoid cysts are rarely cause for major concern if treated appropriately.

When to Consider Removing Non-Painful Epidermoid Cysts

Since epidermoid cysts are typically painless, removal is not necessarily required unless they become problematic. However, a doctor may recommend considering preventive cyst removal or treatment if:

The cyst is rapidly growing larger or changing in appearance
Signs of inflammation or infection develop
The cyst ruptures, leaks fluid, or bleeds
It interferes with normal activities or motion
It becomes cosmetically unappealing
New cysts repeatedly develop over time
The cyst is located in a sensitive or challenging location
Cancer is suspected based on imaging or biopsy

Otherwise, monitoring harmless epidermoid cysts through regular skin exams is generally sufficient. Avoid attempting “do-it-yourself” cyst removal techniques to prevent complications like infection, scarring, bleeding, or recurrence.

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Key Takeaways: Are Epidermoid Cysts Painful?

Epidermoid cysts are typically non-painful, slow-growing lumps under the skin filled with keratin material.
Cysts can sometimes become tender and painful if they become inflamed, infected, or rupture.
Seek medical care for cysts that are red, swollen, warm, draining fluid, or causing severe pain.
Self-care tips like warm compresses, OTC pain medication, looser clothing and avoiding irritation may help manage mildly painful cysts.
Persistently painful or worsening cysts may require drainage, oral antibiotics, steroid injections or surgical removal.
With appropriate treatment, painful epidermoid cysts generally heal without major complications or concerns.
Preventive removal of non-painful cysts is optional, but may be recommended in certain cases.

References

Foster, K. W., Dwyer, P. K., & Jimenez, S. A. (2022). Epidermoid Cyst. In StatPearls. StatPearls Publishing.

Gatti, A. V. (2017). Epidermoid and pilar cysts: diagnosis and management. American family physician, 95(2).

Suresh, D. R., Subramanian, A., Subash, A., Esaki, H., & Viruthagiri, N. (2019). Epidermal Inclusion Cyst: A Complication of Piercing-A Case Report. Journal of maxillofacial and oral surgery, 18(3), 434-436.

Tsai, Y. C., Wang, C. N., Wong, T. W., Shen, J. H., Chen, C. T., & Wei, C. Y. (2006). Sonographic appearances of ruptured epidermal inclusion cysts: emphasis on shapes, pericystic changes, and pericystic vascularity. Journal of ultrasound in medicine, 25(1), 115-120.

Wu, X., Li, Z., Li, X., Zhang, J., Wang, H. W., & Fan, J. (2018). Recurrent epidermoid cyst caused by pilosebaceous duct rupture during laparoscopic inguinal hernioplasty. Urology case reports, 17, 7-9

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