Self Cyst Removal, not self trepanation

December 1, 2005 3:10 AM

I have what's been diagnosed as a harmless sebaceous cyst under my hair. Can I cut it open with an Exacto or Stanley knife?

I've always had them. Sometimes they pop, leaving a mess of cheesy, incredibly foul-smelling goo in my hair. This one is about the size of a half dollar, and is not going away/ bursting after about 4 years, but is consistently red and painful.

With earlier ones, I've asked about getting them cut out from a doctor, but I do not want to incur the expense, nor have to shave my head, as the doc would want to do. It feels like it's just under the skin.

Do you think I should cut it out with some type of sharp, sterile blade?

posted by Dag Maggot to health & fitness (28 comments total)

I'd say no. Does the cyst represent any ongoing health risk? Is it any problem with regard to undermining self-image/looks? I suspect the answer to both is no, and if it is no then there's no reason to start hacking at it with a blade.
posted by biffa at 3:15 AM on December 1, 2005

Well, depending on how my hair is combed, it is sometimes visible barely, and it's always something I have to explain at the hair salon, and it smarts a bit.
posted by Dag Maggot at 3:18 AM on December 1, 2005

Shades of this, no?

I would certainly not recommend doing this yourself - it's very difficult to guarantee cleanliness and sterilization in a home environment and you may end up causing a larger problem than you cure.

Can you not go to a "Pay as you go" clinic for a lunchtime appointment and have them do it for a one-off fee?
posted by benzo8 at 3:31 AM on December 1, 2005

Well, I wouldn't think it would be quite as serious as tonsilectomy benzo8. I don't even think it would need anesthetic, because it's close to the surface.

But I take your point about the sterilization - we probably couldn't get it anything like a surgery. I may have to bite the bullet and go see a medico.
posted by Dag Maggot at 3:43 AM on December 1, 2005

I had one on my leg once and stabbed it with a red hot pin and then used antiseptic (alcohol soaked?) wipes from a medicine kit to squeeze all the crap out.
posted by spinoza at 3:55 AM on December 1, 2005

You wouldn't be the only one to wonder this.

Don't do it yourself. The scalp bleeds a lot -- more than is usual for the skin in the rest of the body -- and it could end up getting quite ugly.

I notice from your profile that you're in Australia. I've seen regular GP's who bulk bill (although for a gold-standard job, see a plastic surgeon or dermatologist. Preferably for former) and do this kind of minor surgery. That said, the GP I'm referring to was in the country, and often they do things out of sheer necessity that metropolitan GP's would normally refer to a specialist for.

If you were to do it yourself, I'd recommend washing the area (don't use an antibacterial soap, if you use it incorrectly as most people do you can do more harm than good. Or so I'm told) thoroughly, getting as much hair out of the way as possible (you may want a second person), applying iodine solution (Dettol) with a sterile sponge, and then using a sterile blade. When I say sterile, in both cases I mean something manufactured for medical use. That is, it's come out of those sealed medical packages you get needles in in hospitals. For applying the iodine, sterile alcohol swabs would work to spread it around. Asking say, a St John's first aid person where to get the blade (over the phone so they don't see the cyst and get wise) would probably be a good place to start without generating too much suspicion. Tell them you're going hiking in treacherous conditions and are paranoid about getting injured. Or even "I'm a medical student and I need some new blades for my dissection kit" would work.

Make a tiny (<1 mm) cut and slowly but firmly squeeze out what you can. this will shrink it. if it's not removed properly it may well fill up again. no offence intended, but if you're doing this to yourself in front of a mirror without any experience, you probably won't have much luck removing it properly. draining it is the best bet.br>
I am not a doctor. I'm a medical student who has just happened to be there when quite a few of these things were removed (by a doctor who loved doing it and loved talking about it) and thought I would share what I've learnt.
posted by teem at 4:07 AM on December 1, 2005

derail, but how does one use antibacterial soap incorrectly?
posted by the cuban at 4:37 AM on December 1, 2005

Apparently people don't wash thoroughly enough to kill all of the bacteria on their skin, and those that remain have less competition and are able to colonise to a larger degree that they would have in amongst all of the bacteria that normally inhabit the skin. These ones that aren't killed are the strong ones, and the last thing you want after washing is to only have the strongest bacteria left.

This may be complete bullshit on the part of the person who told me (although they were a doctor), so take it as you will. Thought I'd err on the side of caution and mention it as a precaution to performing self-surgery.

"Preferably the former", in my original message
posted by teem at 5:01 AM on December 1, 2005

thankyou.
posted by the cuban at 5:37 AM on December 1, 2005

Are you in Advertising?
posted by meehawl at 5:39 AM on December 1, 2005

Yes, you can do just-under-the-skin home surgery with very little risk. A friend with a steady hand, iodine or betadine, bacitracin ointment, an old towel, some ice, and a razor blade ought to do it. Sterilization is always a plus, but really, you have the body's natural defenses working for you here: you're going to make a small cut and then squeeze crap out, which means any germs you might introduce are going to immediately exit the body along with blood and pus. The extra bleeding from a scalp wound will work in your favor here.

I'm assuming that you don't have any problems with blood clotting, that you have a normal immune system, etc. The human body is quite resilient in most respects. Look at it this way: suppose you got a 1cm cut in your scalp - would you run to the hospital? Would you die? If the answer to these are no, you can self-inflict a small cut as well.
posted by jellicle at 5:50 AM on December 1, 2005

I had that. Just make sure it doesn't get infected, or else there is a long and painful removal and convalescence procedure.
posted by jon_kill at 6:01 AM on December 1, 2005

Meehawl. That was a good quirky flick. So far no facial features, so I'll get it out while the gettings good.
posted by Dag Maggot at 6:03 AM on December 1, 2005

Don't do it yourself. I had something similar at the base of my hairline on the back of my neck. I went to a clinic and had a surgeon deal with it -- she injected some lidocaine, sliced the thing open, and excised the stuff inside... but after scraping all the stuff out, what's left behind is a space inside that could very VERY easily become infected. She packed it with gauze, and for two weeks, I had to have the thing unpacked, cleaned out with sterile fluid, and repacked, until the space closed up and healed (basically every day there would be less and less space to pack). It was painful and messy, and I would be very leery of trying to do this sort of thing yourself. Also, if you don't get all the stuff out (which would be very difficult to do if you're doing this solo, since you can't see what you're doing as well as someone else can), there's a high probability that the cyst will return. And then you might need real surgery, not just lidocaine and squeezing/scraping. I say suck it up and go to a real doctor.
posted by youarejustalittleant at 6:46 AM on December 1, 2005

Apparently people don't wash thoroughly enough to kill all of the bacteria on their skin, and those that remain have less competition and are able to colonise to a larger degree that they would have in amongst all of the bacteria that normally inhabit the skin. These ones that aren't killed are the strong ones, and the last thing you want after washing is to only have the strongest bacteria left.

You cannot get rid of all the bacteria on your skin by washing. Even if you scrub for 20 minutes, you're just reducing the numbers (which will recolonize once you step out of the shower).

I've removed several of these as a medical student in surgery clinic, under the supervision of a surgeon; we always used sterile gloves, sterile supplies, and created a sterile field. And we closed the incision with two stitches. I'd imagine a family practice doc could do it without having to see a surgeon.
posted by gramcracker at 6:46 AM on December 1, 2005

Don't think squeezing alone works. I had one removed a couple of years ago, and the surgeon told me that the fluid gathers inside a sac, which must be removed (scraped out) as well, or the cyst will just refill. I can testify to the refilling after a couple of prior bouts of self-surgery obviously weren't sufficient to do the job.
posted by bifter at 7:14 AM on December 1, 2005

Theres a video of the removal of one of these that could show you exactly what you're dealing with, called 'worlds biggest zit'

NSFW - not safe for anyone really

here
posted by jeffmik at 7:42 AM on December 1, 2005

For people watching that video: it's not a tumor, it's a cyst. And that's not pus, that's sebum, the oil that your body's sebaceous (oil) glands naturally make.
posted by gramcracker at 8:00 AM on December 1, 2005

Starlight!!

Seriously, while a medic might be the person to tackle any major cutting, you might first try soaking a washcloth in very hot water and applying to the area for a while, then removing the cloth and gently applying pressure -- it might open the pores enough to drain. It's worked for me.

Minor proding with sharp objects might work, but yes, the head bleeds a lot. Keep things sterile and have some antibiotic ointment handy.
posted by mumeishi at 8:08 AM on December 1, 2005

My strong recommendation is to see a dermatologist. It's very unlikely that if you do this at home you'll be able to remove the cyst sac. Leaving it in can lead to recurrence.

I started getting these when I was a teenager. At first I went to a surgeon, who cut back a bit of my hair and did the incision and stitches thing.

However, years later when I had a recurrence, I went to a dermatologist who made a tiny incision, expressed cyst, then forced the incision open and slipped the sac through the small opening. In only one instance was the cyst inflamed or enlarged to the point that a single stitch was necessary.
posted by Sully6 at 9:22 AM on December 1, 2005

World's biggest zit? Rubbish, I had things like that before... on my face. My mother gets these too, but elsewhere on the body.

Rule of thumb: if it's smaller than your thumb, DIY. If not go to a doctor. I'll do it ;)
posted by methylsalicylate at 9:33 AM on December 1, 2005

I had a small sebaceous cyst on the back of my head. It eventually started to hurt a bit so I asked my family doctor to remove it. He did it in his office in a few minutes. Unfortunately, the scar it left is just as big and hard as the cyst ever was.

I had another near my right shoulder blade. The hot washcloth trick mumeishi mentioned above (without any pressure!) resulted in it self-draining. The next day I went back to the same doctor to have the sac removed so it wouldn't re-fill. Now I've got a quarter-sized shiny pink divot on my back. I guess my doc isn't so hot at stitches. :P
posted by xiojason at 9:58 AM on December 1, 2005

I've opened small cysts and suchlike, with no ill effect, but I think one that was a silver dollar in size would have me visiting a physician.
posted by five fresh fish at 10:11 AM on December 1, 2005

One strong vote against DIY.

I had a cyst under the skin at the hairline. It nagged me for a while, so I thought, hey, I can handle this.

I cleared hair from the area, used a sterilized blade, prepped with iodine, and...
wound up with a massive strep infection in my face. Woke up the next day with my right eye swollen shut, and red streaks spreading from the cite of the cyst across my head.
My internist admitted me to the hospital immediately to administer I.V. antibiotics. The infection took over a week to clear completely.
So, uh, no. I would never attempt home surgery again.
posted by fearless_yakov at 10:18 AM on December 1, 2005

As the one who applied the hot washcloth to xiojason's cyst, I will add the following:

I put the cloth on it for a bit, then lifted it to see what was going on. I touched the edge of the cyst to see how it was doing. I didn't press at all, just a slight touch. And the damn thing burst with sebum flying several feet across the room! It was spectacular but very, very nasty.

I kept putting the warm washcloth on and drained as much as possible. Gah. It was so gross.
posted by litlnemo at 10:31 AM on December 1, 2005

A similar story to fearless_yakov's, via my ex-bf (this happened a few years before he and I met): my ex had a small sebaceous cyst on his face (right below his nose, I think) that he tried to slice/drain himself, and within a few days wound up a staph infection so bad that the doctor wanted to hospitalize him immediately. (My ex is so doctor/medicine-phobic that he refused hospitalization, but did agree to a course of hardcore antibiotics.)
posted by scody at 1:42 PM on December 1, 2005

I think the Staphylococcus tales amount to a pretty firm no, no, NO, hell no, hmm?
posted by nanojath at 8:42 PM on December 1, 2005

My vote: don't DIY! It's in an awkward spot up there, the risk of infection is non-negligible, and it's exceedingly unlikely you'll be able to excise all of the cyst wall, in which case it will just return.

You do NOT want it to get infected. I had an infected sebaceous cyst removed from my back (no idea how it got infected; it had been there minding its own business for years). Hurt like a motherfucker (the cyst, not the surgery; I had a local for that) and I had to take some hardcore antibiotic that played hell with my guts for a week and a half. Left a hole the size of Utah so I had to have the packing-and-unpacking-with-gauze business described by youarejustalittleant. (That didn't hurt, but it was annoying to have to keep going back.)

If I'd had the evil little bastard removed while it wasn't infected it would have been a simple slash'n'yank job, according to my doctor. A healthy cyst wall is easy enough to pull out whole in most cases, but an infected one is friable and you have to scrape it out in bits.

If you really don't want to get shaved and cut professionally, ask your GP just to drain it. They'll warn you that it'll be back, and it will, but at least it will be gone for some months.
posted by sennoma at 10:36 PM on December 2, 2005