Overview

Okay, let's talk about Pilar Cysts, sometimes called Trichilemmal Cysts. I understand that finding a new lump or bump on your skin can be worrying, and I'm here to help you understand what this might be.

A pilar cyst is a common, harmless (benign) bump that forms out of a hair follicle, most often on the scalp. These cysts are essentially sacs filled with keratin, a protein that makes up your hair and nails.

Pilar cysts tend to run in families, suggesting a genetic link plays a big role in who gets them. They are most commonly found in middle-aged adults, and women are slightly more likely to develop them than men. The good news is that pilar cysts are not contagious at all. While usually not a major health concern, a pilar cyst can sometimes become tender, inflamed, or simply be a cosmetic concern for you.

Symptoms

You might notice a pilar cyst presenting with some of these common features:

• A smooth, firm, dome-shaped bump under the skin.
• Most commonly found on the scalp (about 90% of cases), but can occasionally appear on the face, neck, or trunk.
• The cyst is usually flesh-colored or may appear slightly whitish.
• It typically grows slowly and can range in size from a small pea to several centimeters across.
• Usually, pilar cysts are not painful unless they become inflamed, infected, or rupture.
• The skin over the cyst is usually normal, and there's no central opening or "blackhead" like you might see with an epidermoid cyst.
• You might have just one, or you could develop several pilar cysts.
• The cyst feels like it can be moved slightly under the skin.

Diagnosis

Diagnosing a pilar cyst is often straightforward for a healthcare professional.

• Typically, a doctor can diagnose a pilar cyst based on its appearance and location, especially if it's a classic firm bump on the scalp.
• They will likely ask you about your medical history and if any family members have similar cysts.
• In some cases, especially if the diagnosis isn't clear or if there are concerns, a doctor might suggest a biopsy. This involves taking a small sample of the cyst to be examined under a microscope.

Management & Treatment

Living with a pilar cyst is usually not a cause for concern, and many people find that their cysts don't require any treatment at all. Often, these cysts can even resolve on their own. However, if a cyst becomes tender, inflamed, or you simply don't like its appearance, we have gentle and effective ways to help you.

It's always a good idea to have any new lump or bump on your skin looked at by a healthcare professional to make sure it's a pilar cyst and not something else. Once you have a diagnosis, you can explore your options.

Home Care and Self-Management

For a little bit of at-home comfort, you can try applying a warm, moist washcloth to the cyst for about 15 minutes a few times a day. This warmth can sometimes help the cyst shrink and feel better.

One very important tip: Please don't try to squeeze, pop, or drain the cyst yourself. We know it can be tempting, but doing so can push the inflammation deeper, lead to infection, and potentially cause scarring. We want to help you avoid that.

When to Consider Medical Treatment

If your pilar cyst is causing you discomfort or you'd prefer to have it removed, a simple in-office procedure is the most common and effective treatment. This is typically done by a dermatologist. The main goal of treatment is to remove the entire cyst, including its lining, to prevent it from coming back.

Here are the most common approaches:

• Surgical Removal: This is the gold standard. After numbing the area so you won't feel a thing, the doctor will make a small incision and remove the entire cyst. This is a quick and safe procedure that is very effective at preventing the cyst from returning.
• Minimal Excision Technique: This is a variation where a very tiny incision is made. The contents of the cyst are gently squeezed out, and then the cyst wall is carefully removed through that small opening.

What If the Cyst Is Inflamed?

If your pilar cyst becomes red and sore, it might be inflamed or infected. In this case, your doctor might first treat the inflammation. This could involve:

• Injections: A steroid can be injected into the cyst to help calm the swelling and irritation.
• Incision and Drainage: If the cyst is painfully swollen, your doctor may make a small cut to drain the contents and relieve the pressure.

Once the inflammation has settled down, you can then discuss having the cyst wall removed to prevent future problems.

We want you to feel confident and informed about your choices. If a treatment isn't working or if the cyst comes back, please don't hesitate to reach out to your healthcare provider. We are here to support you on your journey to healthy skin.

Duration & Outlook

Pilar cysts behave in different ways for different people, but here's a general idea:

• Pilar cysts are generally considered chronic, meaning they can be present for many years and often don't go away on their own.
• They often remain stable in size for long periods, though some may slowly enlarge over time.
• Occasionally, a cyst might rupture under the skin, leading to inflammation, pain, and tenderness. It can also sometimes become infected.
• The outlook is generally very good, as these cysts are benign (not cancerous).
• Warning signs for complications include sudden rapid growth, redness, significant pain, warmth to the touch, or pus-like discharge. If you notice these, it's important to see a healthcare professional.

Prevention

Unfortunately, because pilar cysts are strongly linked to genetics and the way hair follicles develop, there isn't a known way to prevent them from forming. If you have a family history of pilar cysts, you may be more likely to develop them, but this is largely out of your control.

Causes & Triggers

Understanding what might be behind your skin concerns is so important.

• Pilar cysts are caused by the buildup of keratin (a skin protein) within the lining of a hair follicle, specifically from a part called the outer root sheath. The cyst wall is very similar to this part of the hair follicle.
• The primary cause is believed to be genetic predisposition. They often run in families, meaning if your parents or siblings have them, you might be more likely to develop them too.
• Unlike some other skin conditions, there aren't typically specific external "triggers" like foods or environmental factors that cause pilar cysts to appear.
• They are most common in adults, particularly middle-aged individuals, and occur more frequently in women.
• Injury to a hair follicle has sometimes been suggested as a possible, though less common, contributing factor for some cysts.

When to see a doctor

While pilar cysts are usually harmless, it's always wise to get a professional opinion, especially if you're worried or notice changes. You should consider seeing a doctor or dermatologist if:

• You notice a new lump or bump and are unsure what it is.
• The cyst becomes painful, tender, red, or swollen.
• The cyst starts to grow rapidly.
• You see any signs of infection, like pus or discharge from the area.
• The cyst ruptures.
• The cyst is bothering you for cosmetic reasons, or it's in a location where it frequently gets irritated (like by a comb or hat).

Remember, it's always better to have a healthcare professional take a look if you have any concerns about your skin. They can provide an accurate diagnosis and peace of mind.

Frequently Asked Questions (FAQs):

• Q: Are pilar cysts cancerous? No, pilar cysts are benign, meaning they are not cancerous. Malignant (cancerous) change in a pilar cyst is extremely rare.
• Q: Can I squeeze or pop a pilar cyst? It's strongly advised not to try and squeeze or pop a pilar cyst. Doing so can cause it to rupture under the skin, leading to inflammation, pain, and a higher risk of infection. It can also make the cyst more difficult to deal with later.
• Q: Do pilar cysts go away on their own? Most pilar cysts do not go away on their own. They tend to be persistent unless they are surgically removed. Sometimes they can rupture and shrink, but the cyst wall often remains, and it can refill.
• Q: What's the difference between a pilar cyst and an epidermoid cyst? Both are common skin cysts, but they originate from different parts of the skin. Pilar cysts come from the hair follicle lining (outer root sheath) and are most common on the scalp. Epidermoid cysts come from the epidermis (the top layer of skin) and often have a central pore; they can appear anywhere on the body. A doctor can usually tell the difference.
• Q: If I have one pilar cyst, will I get more? It's possible. Some people only ever have one, while others, particularly those with a strong family history, may develop multiple pilar cysts over time.

Living with any skin condition, even a generally harmless one like a pilar cyst, can sometimes cause worry or frustration. Please remember that getting an accurate diagnosis from a healthcare professional is the most important first step. They can help you understand your specific situation and discuss any concerns you might have.