Hello, this is Dr. Kohrita from Kohrita Hiro Orthopedic and Plastic Surgery Clinic, located in Shin-Osaka, Yodogawa Ward, Osaka City.
Today, I would like to share a case where an inflamed epidermoid cyst was successfully removed using the punch excision method, and the surgical site was no longer visible even 4 years after surgery.
◆ About the Patient
The patient was in their 30s and had noticed a cyst on the neck for about a year.
Several days before visiting our clinic, the area gradually became larger and painful.
The patient visited a nearby dermatologist (○○ Dermatology) 4 days before coming to us.
There, they were told:
“The inflammation is too severe, so we can’t perform surgery right now. Let’s start with antibiotics and observe for now.“
However, after taking the prescribed antibiotics, the condition did not improve at all—in fact, it worsened, with increasing swelling and pain that became severe enough to cause sleepless nights.
◆ First Visit to Our Clinic
Looking for a clinic that could treat even inflamed cysts surgically, the patient found our clinic online and came to us seeking surgery.
I explained the following key points clearly:
✅ 1. Antibiotics do not work for inflamed epidermoid cysts
Inflammation occurs inside the cyst capsule, which has no blood supply.
This means that no matter what antibiotic is taken, it cannot reach the inside of the cyst and will have no effect.
So again, antibiotics are ineffective for inflamed epidermoid cysts.
✅ 2. Surgery is possible even in severe inflammation
Even when a cyst is inflamed, it can be safely and effectively removed.
We have successfully treated many inflamed cysts using the punch excision method, as seen in many other cases on this blog.
Upon hearing this explanation, the patient looked relieved.
However, they were also a bit upset and said:
“What was the previous doctor even talking about…?“
As a fellow medical professional, I sincerely apologized on their behalf.
◆ Surgery and Postoperative Care
We proceeded with punch excision to completely remove the inflamed cyst, including its capsule.
-
No antibiotics were administered pre- or post-operatively
-
The wound was managed using Natsui-style moist wound healing
-
No disinfection or gauze changes were needed
-
The patient was allowed to shower and bathe from the next day
-
There were no signs of infection or recurrence
◆ 4-Year Follow-Up Visit and Outcome
Four years later, the patient returned to our clinic for treatment of another cyst in a different location.
During this visit, we checked the neck area where the previous cyst was removed and were allowed to take a photo of the surgical site.
The patient happily told us:
“I can’t even tell where the surgery was done. Thank you so much for the beautiful result.“
It was truly gratifying for me to hear this and to see such an excellent long-term outcome.
A painful, swollen sebaceous cyst on the neck. The patient was previously advised to wait with antibiotics, but we performed punch excision at our clinic.
Drainage of pus-like contents from an inflamed sebaceous cyst on the neck. The cyst wall was later removed completely using the punch excision method.
Surgical removal of the cyst wall from an inflamed sebaceous cyst on the neck. Even in inflamed cases, punch excision enables complete removal.
This is the immediate postoperative view after punch excision of an inflamed sebaceous cyst on the neck. The wound is small and the cyst wall has been fully removed.
Day 2 after surgery. The patient reported almost no pain, saying, “It’s surprisingly painless.” There were no signs of infection.
This is the wound on day 4 after surgery. Redness has significantly improved, and there is no pain or infection. The patient said, “It feels like I never had surgery.”
This is the wound on day 14 after surgery. It is almost completely healed, with no signs of pain or infection. Full recovery is expected within a week.
This is the neck five years after punch excision and Natsui-style moist wound healing. The surgical site is no longer identifiable, and the patient has no symptoms.
If you are struggling with an inflamed cyst or were told “surgery isn’t possible due to inflammation,” please know that there is a better, evidence-based option available.
We are committed to providing accurate and compassionate care to all patients.
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.
