Pilar Cyst

What is a pilar cyst?

A pilar cyst or medically known as trichilemmal cyst is a type of cyst containing keratin. It comes from the outer hair root sheath.

What is keratin? It is a type of protein that consist the nails and hair. A pilar cyst is usually found on the scalp and are prevalent in middle-aged women. ⁽¹⁾

Pilar cyst clinical features

A pilar cyst looks like an epidermoid cyst. Sometimes, it is referred as a sebaceous cyst. What is inside a pilar cyst? What it looks like? A pilar cyst is a firm and mobile subcutaneous nodule, usually 0.5 to 5 cm in diameter. Unlike the epidermoid cyst, pilar cyst does not have a central punctum.

It can grow in one area, but can also be found in more than one area. It looks smooth, but once inflamed, it can be very painful. Over time, a pilar cyst can grow in size and can burst spontaneously causing irritation, pain, and redness.

When a pilar cyst gets big, hair loss where the pilar cyst grows happen. If the cyst gets infected, it could rupture, which produce a very foul smell. In some instances, a horn appear over the infected area making the cyst unsightly to look at. ^{(1, 2, 3)}

Pilar cyst Pictures

 

Image 1: Two identical pilar cysts on the scalp of a patient.
Picture Source: www.regionalderm.com

Photo 2: Removal of a pilar cyst on the head
Image Source: i.ytimg.com

Image 3: An infected pilar cyst.
Photo Source: healthool.com

Who are at risk?

Pilar cyst cancer is common in 5% to 10% population in the United States. It does not have any known racial predilection, but can be gender sensitive.

Studies revealed that woman are more prone to pilar cyst than men. It is more prevalent in middle-aged people than the younger population. ⁽³⁾

Causes of cysts on the head

There are a lot of factors leading to the formation of pilar cyst on the head. They include the following:

1. Blocked glands – a blocked sebaceous gland is one of the reasons for the formation of pilar cyst.
2. Cells on the skin’s surface – Cells located near the skin surface can go in the deeper parts of the skin. They will multiply and will then form a sac containing keratin. ⁽⁴⁾
3. Heredity – A lot of people experience pilar cyst right after puberty. In fact, a pilar cyst has something to do with your family’s genes. If your parents or any member of your family suffer from pilar cyst, then most likely you are prone to having a pilar cyst too.
4. Skin injury – A pilar cyst can grow after a skin injury. Severe trauma on the skin could lead to the formation of keratin. The skin infection hastens the formation of thick lumps. ⁽⁵⁾

Pilar cyst treatment

The goal of pilar cyst treatment is to remove the cyst using the surgical approach. Pilar cyst removal cost a lot. It can cost $200 to $300 depending on the size, location, and severity of the cyst. For a less invasive pilar cyst removal, a cyst enucleation is done.

This procedure removes the cyst without cutting it thereby keeping the surrounding skin intact. However, the doctor will conduct a thorough examination of the cyst to determine if it is a suitable for enucleation procedure.^{(4, 5, 6)}

As with the usual pilar cyst removal approach, the doctor will create an incision and the content of the cyst will be expressed. To thoroughly remove the cyst wall, a surgical punch is created, which facilitates expression of the cyst through the hole. If the cyst is infected, the doctor will prescribe antibiotics.

Many doctors suggest that the cyst should be left untreated, especially if it is not infected and does not grow in size. Removal is warranted if the pilar cyst gets infected and grows in size. Removing the cyst because it is a sore to the eye is usually discouraged by the doctor.

Why? This is to preserve the integrity of the skin. A surgical removal of pilar cyst is done under anesthesia. The doctor will make a small cut and after the content of the cyst is removed, a row of stitches will close the skin.

A pilar cyst is usually benign (non-cancerous). If you have a pilar cyst and it does not show any signs of infection, but still you want to have it removed, then you should talk to your surgeon. ^{(7, 8, 9, 10)}

Pilar cyst home treatment

Do you have a pilar cyst? Do you want to have it removed but you don’t have enough money to pay for the removal cost? If yes is the answer to these questions, then don’t worry because there are home treatments for pilar cyst.

However, you have to keep in mind that pilar cyst removal at home can only be done if the pilar cyst is not infected or has not yet ruptured.

1. Use a cyst removal product – There are now cyst removal products and kits that allow you to remove pilar cysts right in the comfort of your home. It is usually in the form of shampoo or gel. It contains natural ingredients tested and proven effective in treating scalp problems.
2. Warm compress – A heat therapy like warm compress can help get rid of pilar cyst. Just make sure that you don’t squeeze the cyst. If you accidentally pop open the pilar cyst, there will be a high possibility of infection. If the pilar cyst requires draining, do not ever attempt to drain the cyst on your own, not unless you have a medical background and you know what you are doing. If the pilar cyst needs to be drained, you can skip this at home and let the medical professionals do it for you. Any types of cyst should be properly drained. Failure to do so could put you at risk for infection. ^{(4, 5, 8)}

Reference:

1. https://en.wikipedia.org
2. emedicine.medscape.com
3. www.skinsight.com
4. www.healthresource4u.com
5. healthool.com
6. www.mdedge.com
7. www.hxbenefit.com
8. www.ehealthstar.com
9. www.steadyhealth.com
10. www.patientcareonline.com
11. Field Guide to Clinical Dermatology edited by David H. Frankel