Pilar Cyst

A pilar cyst, also known as a trichilemmal cyst, is a common type of benign skin lesion. It develops from hair follicles. These slow-growing, painless bumps usually appear on the scalp but can also occur on other parts of the body.

While pilar cysts are generally harmless, they can cause cosmetic concerns or become inflamed. This might prompt individuals to seek medical evaluation and treatment. Knowing the causes, symptoms, and available management options for these benign tumors can help those affected make informed decisions about their skin health.

What is a Pilar Cyst?

A pilar cyst, also known as an epidermal inclusion cyst or trichilemmal cyst, is a common type of noncancerous cystic lump that develops beneath the skin. These cysts are filled with keratin, a protein found in hair, skin, and nails.

Pilar cysts appear as smooth, firm, and mobile lumps under the skin’s surface. They are usually painless and slow-growing, ranging in size from a few millimeters to several centimeters in diameter. In some cases, these keratinous cysts may become inflamed or infected, leading to tenderness, redness, and swelling in the affected area.

Location and Appearance

Pilar cysts most commonly develop on the scalp, at the back of the head near the hairline. They can also occur on other parts of the body where hair follicles are present, such as the face, neck, and trunk. These cysts are more frequently found in middle-aged or older adults, with a higher incidence in women compared to men.

The appearance of a pilar cyst can vary depending on its size and location. They are usually round or oval-shaped, with a smooth surface that may be flesh-colored, white, or yellowish. When a cyst is intact, it feels like a firm, rubbery cystic lump that can be easily moved under the skin. If the cyst ruptures or becomes inflamed, it may appear red, tender, and swollen, resembling a small boil or abscess.

Causes and Risk Factors of Pilar Cysts

Pilar cysts, also known as trichilemmal cysts, can develop from several factors. They usually form from the outer root sheath of hair follicles. Knowing what causes them can help in managing these benign skin lesions.

Genetic Predisposition

Genetics play a big role in pilar cyst development. If your family has a history of these cysts, you might get them too. Specific genes that cause them are not yet known.

Age and Gender

Pilar cysts often appear in people aged 45 to 65. Women get them more often than men. Hormones and hair follicle traits might explain why women are more affected.

The table below shows how age and gender affect pilar cysts:

Hair Follicle Trauma

Damage or inflammation to hair follicles can cause pilar cysts. Activities that rub or press on the scalp can lead to these nodules. Wearing tight headgear or styling hair tightly can increase your risk.

Sebaceous cysts and pilar cysts are different. Sebaceous cysts come from sebaceous glands, unlike pilar cysts which come from hair follicles.

Symptoms and Complications

The most common symptom of a pilar cyst is a firm, skin lesion on the scalp. This cystic lump is usually painless and grows slowly. It may feel smoothly rounded or have an irregular shape.

While pilar cysts are benign tumors, they can sometimes cause discomfort or become inflamed.

In some cases, a pilar cyst may rupture. This can lead to redness, swelling, and tenderness. If the cyst becomes infected, you might also see:

Complications from pilar cysts are rare but can happen if left untreated or irritated often. These include scarring, hair loss, and a very rare squamous cell carcinoma.

Diagnosis of Pilar Cysts

Getting a pilar cyst diagnosed right is key to finding the best treatment. Doctors start by carefully checking the area with a physical exam. They look at the size, where it is, and how it looks to see if it’s a pilar cyst.

At times, doctors might use imaging tests to learn more. Ultrasound scans can show the cyst’s size, depth, and what’s inside. If the cyst is near important parts or looks big and complex, CT scans or MRI might be used.

To be sure it’s a pilar cyst and not something else like a sebaceous cyst, a biopsy might be done. This means taking a small piece of tissue from the cyst for a pathologist to look at under a microscope. The biopsy results can confirm the diagnosis and help decide on treatment.

Physical Examination

During the physical exam, doctors closely check and feel the cyst. They look at its size, shape, feel, and if it’s inflamed or sore. Finding a small, firm, and movable nodule under the skin suggests a pilar cyst.

Imaging Tests

Imaging tests are not always needed but can be helpful in some cases. Ultrasound is the most common test for pilar cysts. It shows detailed images of the cyst’s inside and if it’s solid or filled with fluid. Rarely, CT or MRI scans might be needed for big or unusual cysts.

Biopsy

A biopsy is often done to get a clear diagnosis. The doctor numbs the area and takes a small tissue sample from the cyst. This sample is then checked in a lab. Under the microscope, pilar cysts show specific features like keratin-filled cavities and a thin lining.

Treatment Options for Pilar Cysts

Pilar cysts, also known as trichilemmal cysts, epidermal inclusion cysts, or keratinous cysts, have several treatment options. These choices depend on the cyst’s size, location, and symptoms. Doctors consider factors like patient preference, cosmetic concerns, and possible complications when deciding on treatment.

Observation and Monitoring

For small, painless pilar cysts, watching and waiting might be the best choice. If the cyst doesn’t cause pain, swelling, or affect your appearance, your doctor might suggest not treating it. Regular check-ups can help track any changes in the cyst’s size or look.

Surgical Excision

Surgical removal is the most common and effective way to treat pilar cysts. This involves making a cut in the skin and removing the whole cyst, including its outer layer, to prevent it from coming back. The surgery is usually done under local anesthesia in an outpatient setting. After, the wound is closed with stitches, and a scar may form at the site.

Minimally Invasive Procedures

For some cases, less invasive methods might be considered. These include:

• Laser therapy: This uses laser energy to heat and destroy the cyst without cutting. It might leave less scarring than surgery.
• Aspiration: A fine needle is used to drain the cyst, making it smaller. But, this method alone might not remove the cyst’s outer layer, which could lead to it coming back.

Your dermatologist or healthcare provider will talk to you about the best treatment for your pilar cyst. They’ll consider the cyst’s size, location, and your personal preferences and concerns.

Home Remedies and Self-Care

While seeing a doctor is often needed for pilar cysts, some home remedies can help. Applying warm compresses to the area can ease pain and help the cyst drain. This can make you feel better and help the skin heal.

To use a warm compress, follow these steps:

It’s important to avoid trying to squeeze or pop the cyst at home. This can cause inflammation, infection, and scarring. If the cyst hurts, gets red, swells, or has discharge, see a doctor right away.

Keeping the skin clean can also help. Wash the area with mild soap and warm water. Pat it dry with a clean towel. Don’t use harsh scrubs or exfoliants, as they can make things worse.

Prevention Strategies

While benign tumors like pilar cysts may not be entirely preventable, there are steps you can take. Protecting your hair follicles and keeping your skin healthy can lower the risk of pilar cysts. This way, you can prevent these subcutaneous nodules from forming.

Minimizing Hair Follicle Trauma

To prevent pilar cysts, it’s important to avoid harming your hair follicles. Here are some ways to do that:

• Use a wide-toothed comb to detangle hair, avoiding tangles when wet
• Steer clear of tight hairstyles that can pull on follicles
• Reduce your use of heat styling tools and harsh chemicals
• Wear hats or use sunscreen to protect your scalp from the sun

By being gentle with your hair and scalp, you can lower the chance of follicle damage. This damage can lead to pilar cysts.

Maintaining Skin Hygiene

Keeping your skin clean is also key in preventing pilar cysts. Regular washing removes dirt and oils that can block follicles. Here are some tips:

• Wash your skin with a mild, non-irritating cleanser
• Exfoliate to remove dead skin and clear pores
• Moisturize to keep your skin hydrated and healthy
• Avoid touching or picking at any subcutaneous nodules to prevent infection

By keeping your skin clean and moisturized, you can make it harder for benign tumors like pilar cysts to form.

Remember, while these steps can help, they don’t guarantee you won’t get pilar cysts. If you see new or changing skin lesions, see a doctor right away. They can evaluate and treat them properly.

When to Seek Medical Attention

Pilar cysts are usually harmless, but there are times when you should see a doctor. If your cyst shows any of these signs, get medical help right away:

Seeing a doctor quickly is key to avoid problems like infections. A healthcare provider can check the cyst and suggest the best treatment. This might include surgery or other minor procedures.

If you often get pilar cysts or have a family history, see a dermatologist regularly. They can watch your skin, spot new cysts early, and help prevent more from forming.

Even though pilar cysts are usually safe, it’s smart to be careful with your skin. If you’re worried about a cyst or notice any changes, talk to your doctor. They can give you peace of mind and make sure you get the right care.

Differentiating Pilar Cysts from Other Skin Lesions

Pilar cysts, also known as trichilemmal cysts, have unique features that distinguish them from other skin lesions. It’s important to know these differences for a correct diagnosis and treatment.

Sebaceous Cysts

Sebaceous cysts, or epidermal inclusion cysts, come from the sebaceous glands. They are filled with keratin, a protein in skin, hair, and nails. Unlike pilar cysts, which mostly appear on the scalp, sebaceous cysts can pop up anywhere on the body. They are usually smaller and closer to the surface than pilar cysts.

Lipomas

Lipomas are benign tumors made of fatty tissue. They are soft, movable, and painless. Lipomas can show up on the scalp but are more common on the neck, shoulders, back, and thighs. Unlike pilar cysts, they don’t contain keratinous material.

Dermoid Cysts

Dermoid cysts are present from birth and contain a mix of tissues like skin, hair, and sweat glands. They often appear on the head, neck, or face. Dermoid cysts are deeper and more complex than pilar cysts, needing surgical removal.

If you think you have a pilar cyst or another skin lesion, seeing a healthcare professional is key. They can check the growth and suggest the best treatment based on its type, size, and where it is.

Prognosis and Recurrence Rates

The outlook for people with pilar cysts is usually good. These benign tumors don’t usually pose a big health risk. Most can be removed without problems through surgery. But, there’s a chance they might come back if not all of the cyst is taken out.

Research shows that 5% to 10% of pilar cysts come back after surgery. Several things can make this more likely:

If a pilar cyst does come back, more treatment might be needed. This could be another surgery or treatments like laser therapy. People who get pilar cysts again should keep an eye out for new skin lesions or changes in their cysts.

While you can’t prevent pilar cysts, there are ways to lower your risk. Avoid hurting your hair follicles too much. Keep your skin clean and see a doctor right away if you notice any unusual growths. With the help of a dermatologist, you can manage pilar cysts and lower the chance of them coming back.

Conclusion

Pilar cysts, also known as trichilemmal cysts, are harmless skin growths. They look like smooth, firm, and movable lumps on the scalp. These cysts usually show up in middle-aged and older adults, mostly women.

The exact reason for pilar cysts is not known. But, genetics and hair follicle damage might play a part.

Even though pilar cysts are usually painless, they can hurt or get inflamed if they grow big or get infected. Doctors can spot them by looking and sometimes with tests or biopsies. Treatment depends on the cyst’s size, where it is, and how it feels.

If you think you have a pilar cyst, see a doctor right away. These cysts are not cancer but can look like other skin issues. With the right treatment, getting rid of pilar cysts works well, and they don’t come back often. Knowing about pilar cysts helps keep your skin healthy and deal with any problems fast.