Surgical Removal of an Inflamed Atheroma Using the Punch Technique
– A Case with Virtually No Scar After 4 Years
Hello, this is Dr. Kohrita,
director of Kohrita Hiro Orthopedic and Plastic Surgery Clinic
located in Shin-Osaka, Yodogawa Ward, Osaka City.
In this post, I would like to share a case of an inflamed atheroma
that was removed using the punch excision method,
with almost no visible scar even after four years.
🧑⚕️ About the Patient
The patient was in their 30s.
They had noticed an atheroma (epidermoid cyst)
on their neckabout a year earlier.
However, a few days prior to visiting our clinic,
they began experiencing increasing swelling and pain.
Four days before coming to us,
they visited a nearby dermatology clinic.
At that time, the physician there told the patient:
“The inflammation is too severe to perform surgery now.
Let’s try antibiotics for the time being.”
The patient was prescribed antibiotics,
but the condition did not improve at all.
In fact, the swelling and pain worsened,
to the point where it became difficult to sleep at night.
🏥 First Visit to Our Clinic and Explanation
Searching online for a clinic that could perform surgery
even with inflammation, the patient found our clinic
and came to us for surgical treatment.
I explained the following to the patient:
✅ 1. Antibiotics are ineffective for infected atheromas
The inflammation is occurring inside the cyst capsule.
However, because the capsule of an atheroma has no blood vessels,
antibiotics taken by mouth cannot reach the inside of the cyst.
No matter how strong the antibiotics are, they have no effect.
Let me emphasize this again:
Antibiotics do not work on inflamed atheromas.
✅ 2. Our surgical approach to inflamed atheromas
Just because there is inflammation does not mean surgery
cannot be performed.
At our clinic, we have successfully removed many inflamed atheromas
using the punch excision method.
Many such cases are also introduced on our blog.
Even if the cyst is red and swollen,
surgery can be performed without any problems.
The patient appeared reassured by this explanation.
In fact, they expressed frustration, saying:
“What was that previous doctor even talking about?”
As a fellow physician, I offered an apology on their behalf.
🛠️ Surgery and Postoperative Course
At our clinic, we performed a standard punch excision
of the infected atheroma, removing the entire capsule.
・No antibiotics were used during surgery
・No antibiotics were prescribed postoperatively
・The wound was managed using the
Natsui-style moist wound healing method
・No disinfectants or gauze dressing changes were used
・The patient was able to shower and bathe from the day after surgery
・There were no signs of infection or recurrence
📸 Follow-up After 4 Years
Four years after surgery, the patient returned to our clinic
for removal of another atheroma in a different location.
At that time, we examined the neck area where the previous surgery
had been done and took a follow-up photo.
The patient said:
“I can’t even tell where the surgery was done.
Thank you so much for healing it so beautifully.”
I was deeply grateful to hear such kind words,
and I am glad to be able to share this successful long-term outcome.
Inflamed and painful neck cyst before surgery.
Contents being expressed from a neck cyst using punch excision technique.
The contents (right) and capsule (left) of the epidermoid cyst removed by punch excision.
Day 1 postoperative wound managed with Natsui-style moist wound treatment. No disinfectant or gauze was used.
The wound on postoperative Day 5 shows no infection or pain. Healing is progressing well with moist wound care.
Day 12 after surgery. The wound is nearly healed with no infection or pain, managed with Natsui-style moist wound therapy.
This photo shows the surgical site 4 years after cyst removal. The scar is almost invisible and healing is excellent.
❓ Frequently Asked Questions (FAQ) About Atheromas
Q1. What is an atheroma (epidermoid cyst)?
An atheroma is a benign, sac-like tumor under the skin
that contains sebum and keratin.
It rarely disappears on its own and may become inflamed,
leading to swelling, pain, or pus.
Q2. Can atheromas heal on their own?
No. They may shrink temporarily,
but the capsule remains and often causes recurrence.
Surgical removal is required to prevent recurrence.
Q3. Can surgery be done during inflammation?
Yes. While some clinics may advise waiting,
we can perform the punch excision even during inflammation.
In fact, early surgery often helps reduce pain and swelling faster.
Q4. Are antibiotics effective for inflamed atheromas?
No. Inflammation occurs inside the capsule,
which lacks blood flow, so antibiotics are ineffective.
Complete surgical removal of the capsule is necessary.
Q5. What surgical method is used?
We use the “punch technique” to remove
the entire capsule through a small incision,
minimizing scarring and pain.
Q6. What is the postoperative care like?
We use the Natsui-Style Moist Wound Healing Method,
which involves:
・No disinfection
・No gauze changes needed
・Shower and bath from the next day
・No antibiotics usually required
Q7. Is recurrence possible after surgery?
If the capsule is fully removed,
recurrence is extremely rare.
We prioritize complete capsule removal during surgery.
Q8. How painful is it after surgery?
Most patients report minimal pain, even in inflamed cases.
Many say, “It hurt much less than I expected.”
Q9. Is it better to operate while the atheroma is still small?
Yes. Smaller cysts are easier to remove,
with less scarring and faster recovery.
Delaying surgery may increase pain and complications.
Q10. Is the surgery covered by health insurance?
Yes. Atheroma surgery is covered under national health insurance.
The out-of-pocket cost may vary depending on
the size and location of the cyst.
🔗 [View All Atheroma Blog Posts]
This post was originally written in Japanese and translated
into English using a translation tool.
We appreciate your understanding if some phrases
are not perfectly natural.
