Pilar Cyst

What Is A Pilar Cyst ?

Sebaceous cyst or trichilemmal cyst, commonly known as Pilar Cyst is a swollen sac filled with fluids, much like a gel toothpaste on scalp or anywhere else on the skin which can be easily touched and felt. Mostly they’re found on the scalp because they are made out of hair follicle roots and follicle roots are abundantly found on a person’s scalp. However, they can also be found on other body parts. The portion where a Pilar Cyst develops tends to swell up.

Even though the cysts have tough walls and don’t burst easily, they become soft and inflamed if ruptured. They are very easy to separate from the skin they are growing on. Understandably, it becomes hard to wear a helmet if there’s one on the scalp. It’s surprising to know that as much as 10% population has Pilar Cysts and that too more than 1 cyst. They are otherwise harmless but create a difficulty in doing daily tasks, like wearing a hat or a helmet. They are not painful either, but the person suffering from them will face a difficulty in doing daily activities and chores without any disturbance.

Pilar cyst image | Image Source : Pcds.org.uk Two pilar cysts | Image Source : Pcds.org.uk

Pathology of a typical Pilar Cyst:

In case you get a chance to scan it, in a Pilar Cyst, you’ll find it filled with bright debris of eosinophilic keratinaceous in epithelial cyst. If it is associated with a massive cell reaction, you cam witness a focal burst of the Pilar Cyst. There is a trichilemmal difference on cyst wall which is found on the outer hair follicle sheath. Centrally, it has cholesterol clefts. From the wall of the cyst, a squamous proliferation can be seen. For a pre-existant trichilemmal cyst, you can easily see trichilemmal tumor which is malignant in nature, coming out from it. A transition can be noticed of an eccentric, irregular growth.

Pilar Cysts Symptoms

For a person suffering from Pilar Cyst, there’s no pain or any other negative effects, which is why they barely complain about any kind of pain or tenderness. However, for some cases, patients have had pain. Rarely would a pilar cyst transform into cancer. For most cases, people tend to lose hair and there could be a possibility of a bald spot, though it is quite unusual. The range of this hair loss varies from moderate to mild, depending on the nature of the cyst. Though there aren’t any specific set of symptoms, people suffering from Pilar Cysts ideally tend to show some apparent characteristics like:

  1. In appearance, for most cases, they are white or flesh colored.
  2. Pilar Cysts are of a size of a pea sized, but at times, they could go upto 1 cm to 5 cms.
  3. If the cyst bursts, the pus coming out from it is foul in odour.
  4. If there’s an infection appearing due to the rupture of the cyst, it will turn into red color.
  5. They are usually dome shaped and smooth in structure. They tend to grow slowly until they reach a certain size, and then go ahead to rupture.
  6. They could get itchy at times, and that would make the person touch it or scratch it frequently.
  7. The cysts have keratin, a protein component which is soggy. They become large gradually. Keratin is generally found on skin, hair and nails.
  8. If the cyst grows in size, there is a considerable hair loss.
  9. In case you rub a Pilar Cyst with a clot, you’ll feel irritated over there.
  10. At times a horn could appear on the Pilar Cyst for unexplained reasons and make it look unpleasant.

Pilar Cysts Causes

The occurrence of a Pilar Cyst can be attributed to growth of cells closer to the skin. When they get deeper in the skin and their multiplication is out of control, they form a sac, and produce keratin. Other than this, for many other reasons, Pilar Cysts are formed. Almost 90% Pilar Cysts are formed on the scalp and the rest 10% are formed on the other parts of the body – trunk, face and extremities. Apparently it is more common for women than men.

Here are some other causes for the formation of Pilar Cysts:

  1. When the cells close to skin get deeper and keep multiplying, they develop a sac and produce keratin. More common in women than men. 90% are formed on scalp; can form on other parts of body as well – trunk, face and extremities
  2. Some people tend to inherit Pilar Cysts from their parents. There are high chances of children whose parents have them to suffer from Pilar Cysts.
  3. Skin injuries may also lead to the formation of Pilar Cysts. What happens is, when there is a skin injury, keratin accumulates at that place and sometimes it ends up forming a lump.
  4. Hormonal changes in young people. However, children are not often affected by Pilar Cysts.
  5. High levels of testosterone formation for people who have hit their puberty may also lead to cyst formation.
  6. Failure in proper hair care. In case you have hair follicles which are inflamed and you fail to take care of your hair properly, there will be Pilar Cyst formation.
  7. Blocked sebaceous glands due to failing in hair lubrication. When the sebaceous glands form sebum (the oily substance which lubricates our hair) and they get blocked due to any reason, Pilar Cysts are formed.

Cancerous proliferating Pilar Cyst:

Cancerous proliferating Pilar Cyst is also known as malignant proliferating Pilar tumor. Chances are, it would have started as benign cyst and turned later into a proliferating followed by malignant cyst. This transformation to malignant cyst from a benign cyst is believed to have caused by irritation, inflammation or a trauma of some kind.

If you happen to go for a skin biopsy of a malignant proliferating trichilemmal cyst and base it on histological findings, you can find if it is malignant or benign. To do this, the complete lesion is first excised, and then sent for a histological examination. Now to remove a malignant proliferating trichilemmal cyst, it is advised to go for a surgical excision. The again a patient can also be recommended to go for chemotherapy or radiotherapy if metastases is to be treated, or if the lesions have massive metastatic potential. It goes unsaid that in such cases, the patients should be constantly in touch with the doctors because it is noted that for as many as 30% cases, malignant trichilemmal cysts tend to return.

Breast Pilar Cysts

At times, a Pilar Cyst is also known as Isthmus-catagen or Wen since it is basically epidermoist cyst’s sub-form. As mentioned earlier, they tend to occur more where there is thick concentration of hair growth. However, in rarest of rare cases, they may occur on breasts as well. We know that a Pilar Cyst tends to grow due to an accumulation of massive amounts of keratin in the hair follicles’ root sheaths – all of this happens in a very short time period. Some rare reports have shown that women who have Pilar Cysts or lumps of their breast (s), it tends to become cancerous. This is why it is advised that anything unusual on a breast needs to be checked by a physician at the earliest.

These Pilar Cysts, when they are formed on a breast, they become solid and go for a continuous cell growth – this is when they turn into Pilar Tumors. Is most cases, they are not cancerous, but they increase in size and become so big that a surgery needs to be done to remove them. But if the cyst on a breast does get infected for any reasons, then it could be treated by intake of oral antibiotics.

Treatment for Pilar Cysts

The factors which traditionally determine the course of treatment of a Pilar Cyst are:

  • The type of the cyst
  • If or not the Pilar Cyst is infected
  • The cyst’s location
  • If the cyst is causing any kind of pain or some discomfort.

Depending on these factors, the Pilar Cyst can be treated with some medical assistance or at home.

Medical care needs to be taken if you have a pilar cyst. If they are small in size, the doctor might suggest not treating it as they go away in some time. The doctor will initially examine it with their hands only. Mostly, middle aged women are most susceptible to Pilar Cyst and can also be running in the family. Otherwise, they might give an antibiotic or physically remove it via surgery. Apart from that, you can try some remedies at home after consulting a doctor like:

Either the doctor will prescribe oral antibiotics, or, they can go for removing the cyst physically. For inflammation reduction of cysts, cortisone injections are known to be helpful. If even then it is still infected and getting ruptured, they will be removed surgically. With the help of local anesthesia, it can be removed in minutes as it’s just a minor procedure. If necessary, the doctor might remove some hair surrounding the cyst.

This is how normally a cyst removing procedure takes place – a small cut is made in the cyst post anesthesia injection. Keratin is removed by cyst pressing and using an appropriate tool, the doctor will then take out the sac. The wound is then stitched back with single/multiple stitches. The entire process shouldn’t’ take more than 15 minutes. But if the cyst is infected, then prior the surgery the cyst requires oral antibiotics treatment. If the pus is already out, proper covering of the Pilar Cyst with antibiotics needs to be done.

Post surgery, it may leave a tiny mark. Now even though it has been surgically removed, there are chances that it might grow back in the very same area. Since Pilar Cysts are benign, there is nothing to be worried about. Regardless, it’s always better to consider a doctor’s consultation just to be entirely safe.

Talking about the home remedies, it’s always safe to first ask the doctor before going for any of these. Having said that, one should never try to press or squeeze it at home because that would only cause an infection. Now if the cyst hasn’t ruptured and is considerably small, you can try out the following steps:

  • Shampoo your hair and apply the gel available in markets for such cysts.
  • Use a heat therapy to increase the cure process.

As it is said, prevention is always better than cure, which is why, small things you do can make a significant difference. For instance, here are a few things you can do:

  • Women who take hormonal contraceptives can prevent its occurrence altogether.
  • Keep the eye lashes and eye lids regularly clean. You can use a mild cleanser for keeping the oil glands over there dust free. This will also help them prevent from getting blocked and hence avoiding any kind of infection.
  • Keep getting up from your desk frequently instead of sitting for a long time. This way you can prevent the formation of new ones. Do that instead of sitting continuously at the same place. You can also prevent the formation of new cysts by keeping the already affected area dry and clean.

This way, if you are aware about the Pilar Cysts, you can prevent them or cure them if you get them instead of getting nervous!

Pilar Cysts Pictures


All Image Credit: http://www.pcds.org.uk/clinical-guidance/pilar-cyst-syn.-trichilemmal-cyst

Leave a Reply