What is a Pilar Cyst?
A pilar cyst is also known as a trichilemmal cyst or sebaceous cyst which grows primarily on the scalp but it can appear anywhere on your skin. It is a small sac which can be touched or felt easily. The area of the scalp where the pilar cyst forms usually swells up. The reason why they are most primarily found on the scalp is because they form from the hair follicle roots which are in abundant in the scalp. These are fluid filled cysts and look like an oily toothpaste.
Though pilar cysts have a tough wall but they can be easily separated from the skin. The cysts becomes soft and inflamed if it is touched after its rupture. But they generally don’t burst a lot since they have a tough wall. These cysts do tend to become large and people face difficulty in wearing a helmet or a hat. Around 10% of the population are affected by this type of cyst and usually have more than one cyst.
Pilar cysts are generally harmless but can cause pain to the patient and the patient might not be able to perform his daily chores smoothly.
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If you power scan a pilar cyst, it will show an epithelial lined cyst which is filled with brightly eosinophilic keratinaceous debris. Focal burst of the cyst can happen if it gets associated with a huge cell reaction. If you inspect the cyst wall closely you will find trichilemmal difference that occurs in the outer root sheath of the hair follicle. The keratin centrally is thickly packed that often displays cholesterol clefts.
In the Proliferating trichilemmal cyst, squamous proliferation can be seen coming from the cyst wall.
The Malignant proliferating trichilemmal tumour is seen rising out of a pre-existing trichilemmal cyst. Clear transition is noticed into an area of eccentric irregular growth with malignant cytology.
People suffering from Pilar Cyst do not show any negative effects from the cysts nor do they complain of any kind of pain or tenderness until they rupture. But there have been a few cases where the patient has felt pain and has not been able to perform his or her daily activities conveniently. It is very rare that a pilar cyst develops into a cancer. There can be more than one pilar cyst in the area of the scalp. Around 70% of patients have more than one pilar cyst. People tend to lose hair that can vary from mild to moderate. It is quite unusual that a person have a bald spot on their scalp due to pilar cyst. Pilar cyst does not usually show any kind of symptoms but they possess certain characteristics such as:
Pilar cysts generally occur when the cells are close to the skin and if they get deeper into the skin and continue to multiply, and then they can develop into a sac and make keratin. There are some other reasons as well that help in the formation of a pilar cyst. Around 90% of the pilar cyst develops on the scalp while the remaining 10% forms on the face, trunk and extremities. It is more common in women than in men.
Malignant Proliferating Trichilemmal Cyst
Cancerous proliferating pilar or trichilemmal cyst is also called a malignant proliferating pilar tumour. It may have started as a benign trichilemmal cyst and then turned proliferating trichilemmal cyst before turning cancerous. It is generally assumed that some kind of inflammation, trauma or irritation may have provoked the transformation of a benign cyst to a cancerous cyst.
A skin biopsy helps in diagnosing a malignant proliferating trichilemmal cyst based on some histological findings. The entire lesion is excised and sent for histological examination. Different types of staining techniques are used to find out whether the proliferating trichilemmal tumour is benign or malignant.
Surgical excision is usually recommended to remove the malignant proliferating trichilemmal cysts. Moreover, radiotherapy and chemotherapy may also be suggested in patients to treat metastases and for lesions having excessive metastatic potential.
Patients should be in constant touch with their doctors after the surgery is done in case the lesions and any metastases reoccur. It is generally noted that in 30% cases malignant trichilemmal cysts returns.
A pilar cyst is a sub form of epidermoist cyst and sometimes is also known as wen or Isthmus-catagen cyst. It forms in areas of large hair concentration but it rarely occurs on the breast. A pilar cyst is mostly formed when excess amount of keratin gets accumulated in the root sheath region of the hair follicle in a short period of time.
However, very rare reports have confirmed that a woman who is found to have a lump or a pilar cyst in the breast turns cancerous. So consult your family physician when you notice a lump in the breast.
When pilar cysts show rapid cell growth on the breast and becomes more solid, then they are called pilar tumours. They are generally non-cancerous and becomes so large that they have to be removed surgically. However if the cyst has become infected, then it can be treated with oral antibiotics.
To check if a pilar cyst needs a treatment or not generally depends upon a number of factors such as the type of cyst, the location of cyst, whether the cyst is infected or not infected and you should also check whether the cysts is causing any pain or discomfort. The cyst may either need some medical care or can also be treated at home.
It is best to consult a doctor if you doubt you are having a cyst. The doctor generally examines it with their hands to determine the shape, size, location and firmness of the cyst. Pilar cysts generally affect the middle-aged women and they may run in the family. However some doctors suggest not treating the cyst if it is considerably small in diameter and is not infected. Very small pilar cysts usually go away in a couple of weeks.
Pilar cysts can be treated in either of the two ways. The doctor or the dermatologists will either give an oral antibiotic or physically remove the cysts. Medications such as cortisone injections help in reducing inflammation in the cyst.
If the pilar cyst continues to be infected or get ruptured then the doctor would surgically remove them. It is a minor surgical procedure and the pilar cyst can be treated by the doctor within a few minutes with local anaesthesia also known as punch biopsy. It becomes necessary to pluck the hairs around the scalp since the cysts generally occurs on the scalp.
The doctor first injects the anaesthesia and then makes a small cut in the cyst. The keratin is then removed by pressing the cyst. After the keratin is taken out, the doctor uses a tool to take out the sac. Once it is done, the wound is closed with a single stitch or a few stitches. Multiple cysts can be removed at the same time. This surgical process usually takes around ten to fifteen minutes to complete.
An infected pilar cyst may also require oral antibiotics or some other treatment before or after surgical excision. If the pus has already been formed then incision and drainage should be done along with the covering of cyst wall with proper antibiotics coverage.
A person can also have a small mark after the pilar cyst is removed. It should be noted that the pilar cyst can re-grow gradually in the same area of the scalp even though it had been removed. You can consider a surgical option if the cyst keeps returning.
Pilar cysts are generally benign and hence there is no need to worry. But it is considered best to seek proper advice from the doctor. If it’s cancerous the treatment will depend upon the type of cancer involved.
You should always consult a doctor before trying home remedies to remove a cyst. In case you want to treat your pilar cyst at home. However it is always not advisable to squeeze a cyst on your own. This may lead to infection. In case the cyst is small, uninfected and has not been ruptures, then you can try any of the two ways.
Prevention is Better than Cure
Most kinds of cysts cannot be prevented. But there are a few exceptions.
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