Epidermal inclusion cyst: Description, Causes and Risk Factors:Epidermal cysts represent the most common cutaneous cysts. While they may occur anywhere on the body, they occur most frequently on the face, scalp, neck, and trunk. The term epidermal inclusion cyst refers specifically to an epidermoid cyst that is the result of the implantation of epidermal elements in the dermis. Because most lesions originate from the follicular infundibulum, the more general term epidermoid cyst is favored.Epidermal inclusion cyst result from the proliferation of epidermal cells with in a circumscribed space of the dermis. Their lipid pattern demonstrates similarities to the epidermis. In addition they express cytokeratins which are constituent of the supra basilar layers of the epidermis. The source of this epidermis is often the infundibulum of the hair follicle, as evidenced by the observation that the lining of the two structures are identical.Studies have suggested that human papillomavirus (HPV) and exposure to ultraviolet light (UV) may play a role in the formation of epidermal inclusion cysts. Epidermal inclusion cysts are most commonly associated with trauma, in superficially situated bones such as the calvarium, phalanx, hand, and foot. They are caused by implantation of epithelium under the skin, forming cysts with secondary bone erosion.They grow slowly and are usually asymptomatic until they become inflamed or secondarily infected which is partly due to chemotactic induced for polymorphs by horney layer in the cyst. Older cyst may exhibit calcification or a foreign body reaction. An important finding is the occasional presence of malignancy usually squamous cell carcinoma, basal cell carcinoma and occasional metastatic carcinoma with a possible role of repetitive trauma and inflammation.Risk Factors:Epidermal inclusion cysts are approximately twice as common in men as in women.
They may occur any time in life, but they are most common in the 3rd and 4th decades of life.
They are commonly distributed all over the body but uncommonly reported in the perineum.
Symptoms:Symptoms may include:Round, mobile, smooth surfaced mass.
Slow growing lesion from 5 mm to 5 cm in diameter.
Visible pore may be present at center of lesions.
May be inflamed if cyst has ruptured.
Soft, yellow keratin discharge present.
May have foul odor.
Diagnosis:Ideal workup of the cyst includes fine needleaspiration for diagnosis and bacterial culture for infectedcases. The imaging studies for diagnosis includesonography (using the reflections of high-frequency sound waves to construct an image of a body organ (a sonogram); commonly used to observe fetal growth or study bodily organ), MRI, CT scan and plain radiography.On histopathology cysts are lined with stratified squamous epithelium that contains a granular layer and is filled with keratinous material that is often in a laminated arrangement. Perineal epidermal cyst is a rare presentation and only few cases have been reported.Treatment:Epidermal inclusion cysts do not need treatment if they are asymptomatic. Treat inflamed, uninfected epidermal inclusion cysts with triamcinolone injected under the lesion.Surgery: Epidermal inclusion cysts may be removed via simple excision or incision with removal of the cyst and cyst wall though the surgical defect.If the entire cyst wall is not removed, the lesion may recur. Excision with punch biopsy technique may be used if the size of the lesion permits.Incision and drainage may be performed if a cyst is infected. This may facilitate the clearing of infection; however, it will not eradicate the cyst. Risk and benefits must be discussed with the surgeon.The surgicalexcision includes meticulous dissection withprecaution taken to avoid spillage of the contents andalso to avoid injury to vital structures near by.Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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