PILAR CYST

By Gary M. White, MD

Pilar cysts Two pilar cysts in the scalp.


The pilar cyst (PC) is a cutaneous cyst whose wall resembles the external hair root sheath. It typically occurs on the scalp. Many patients have multiple lesions that are inherited in an autosomal dominant fashion.

Clinical

A slowly growing, soft or firm nodule of the scalp is typical. The lesion is flesh-colored and uninflamed. Multiple lesions are common. Occasionally, a cyst will occur on another part of the body.

Differential Diagnosis

See scalp nodule. Care should be taken in making the diagnosis in the case of a solitary lesion as rarely, a malignancy may present as a scalp nodule.

Treatment

The pilar cyst is relatively easy to remove. The hair in a small area over the cyst (e.g. 1 cm in diameter) is trimmed and the area anesthetized. Waiting a few minutes for the epinephrine to vasoconstrict the vessels is helpful. A 4 mm punch may then be: used to cut through the skin and into the cyst. The contents are extruded using lateral pressure going around in all directions. When the sac is nearly empty, it is usually easily removed with Hempstead or a clamp. One or two 4-0 sutures are then placed epidermally to close the hole and stop any bleeding.

Additional Pictures

Pilar cyst pilar cyst

Too much hair was cut in the second photograph. However, the photo does illustrate well the cyst.
pilar cyst pilar cyst

Excision of a pilar cyst: Hair pulled back and area cleansed. Lidocaine, then small linear excision over the cyst.
Surgical excision of a pilar cyst Surgical excision of a pilar cyst

Cyst punctured, drained and then entire wall removed with forceps (no teeth) as lateral pressure applied. Excision sutured.
Surgical excision of a pilar cyst Surgical excision of a pilar cyst

Surgical specimen: pilar cyst.
pilar cyst, surgical specimen

Occasionally, the pilar cyst will occur in areas other than the scalp--here on the breast.
pilar cyst occurring on the breast

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