What is a trichilemmal cyst?
A trichilemmal cyst (or pilar cyst) is a common cyst that forms from a hair follicle, most often on the scalp, and is smooth, mobile, and filled with keratin, a protein component found in hair, nails, and skin.
A trichilemmal cyst, also known as a pilar cyst, is a keratin-filled cyst that originates from the outer hair root sheath. Keratin is the protein that makes up hair and nails. Trichilemmal cysts are most commonly found on the scalp and are usually diagnosed in middle-aged females. They often run in the family, as they have an autosomal dominant pattern of inheritance (i.e. the tendency of the cysts can be passed on by a parent to their child of either sex, and the child has a 1 in 2 likelihood of inheriting it).
Clinical features of a trichilemmal cyst
Trichilemmal cysts may look similar to epidermoid cysts and are often incorrectly termed sebaceous cysts. Trichilemmal cysts present as one or more firm, mobile, subcutaneous nodules measuring 0.5 to 5 cm in diameter. There is no central punctum, unlike an epidermoid cyst. A trichilemmal cyst can be painful if inflamed. 90% of trichilemmal cysts are found on the scalp and less frequently the scrotum.
• Central punctum is absent
• Origin is outer root sheath
• Cyst wall is thick and not prone to rupture
• Histology: granular layer is absent
Treatment
It is not necessary to remove trichilemmal cysts if they are not causing symptoms. However, incision and drainage under local anesthesia provides comfort and elective excision before rupture prevents scarring.
Surgical treatment involves one of the following methods:
• Removal of the cyst without cutting into it and leaving surrounding skin intact
• Incision followed by expression of contents and removal of cyst wall – this is often best achieved with a surgical punch with the cyst expressed through the hole
Acute inflammation after rupture is often misdiagnosed as a bacterial infection. Antibiotics are of little value unless an actual infection is present.
Citation: Kapadia, A. (2014, June 1). Trichilemmal Cyst. DermNet. Retrieved July 26, 2023, from https://dermnetnz.org/topics/trichilemmal-cyst
Condition photos reproduced with permission from: https://dermnetnz.org/
Written by Danielle Berg, APRN
Starting with https://zonderlimietcasino.net as a comparison point actually made me think about how often cysts get casually mislabeled as sebaceous, which the post points out is technically incorrect. The detail about the thick cyst wall being less prone to rupture than an epidermoid cyst was the part I hadn't appreciated before, and it explains why simple squeezing tends to cause more trouble than relief. Since these often run in families, I'd be curious whether people who inherit the tendency are usually advised to watch for new lumps or just deal with them as they appear.
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