Emergency!

Almost weekly, I will get a call in the office for a patient that needs to be seen for a skin emergency.  Jerry Seinfeld would joke, "What, an emergent pimple?"  (Remember the pimple popper, MD episode?)  In a word, yes.  Usually, the patient is coming in for an infected sebaceous cyst that has become an abscess.  By the time they're seeing me, it's usually because it's grown in size and become extremely painful, and they need treatment, stat!

What is a sebaceous (epidermal) cyst?  It's a closed sac under the surface of the skin that contains material called keratin, which looks like a white, cheesy material.  They can be located almost anywhere: the face, neck, trunk, and groin area are usually the most common.  They are usually caused by genetics, damage to hair follicles, and ruptured sebaceous (oil) glands, commonly seen in acne.  In general, sebaceous cysts are benign growths, and usually, don't need to be treated.

But sometimes, because of the cyst location, or trauma, or other factors, the cyst becomes inflamed: red and tender.  If it's a small cyst, and doesn't look infected, the dermatologist may treat with with a steroid injection.  But if it looks infected, then it will need to be drained.  A small opening is made in the abscess and the infection will drain out.  Often, antibiotics will be given as well for treatment.  It's very important to have an abscess treated by a dermatologist, or the infection will fester and could possibly spread into the blood. Because drained cysts tend to recur, surgical removal of the cyst may be planned once the infection has been treated.

I should point out that other things, such as skin cancers, can look like lumps or bumps under the skin.  Any growths should be checked by a dermatologist.  But Jerry Seinfeld already knew that.