Dermoid Cysts

Dermoid cysts are teratomas which means it is a tumour which is comprised of different types of tissues like hair, muscle or a bone. They are of a cystic nature which means it forms from a cluster of cells which come together to form a sac-like structure with a distinct membrane from the nearby tissues. It contains tissues which are mature and solid. The most frequently found components of dermoid cysts include sweat glands, hair follicles and skin but other things might also be present in the composition of the cyst. These include pockets of sebum which is an oily or waxy matter secreted by certain glands present on the skin, clumps of long hair, nails, cartilage, blood, bone, teeth, fat and thyroid tissue.

These cysts are sac-like structures which are present in an individual at birth. It looks like a cavity or a pocket under the skin and which contains tissues that are generally present on the outer layers of the skin. These dermoid cysts sometimes might also contain fluid, pus or thick white substances identical to what is seen in a pimple. They might sometimes appear to be extending below the skin and can penetrate the bone. In rare cases, they might develop inside the body. This pocket or cyst or mass of tissues might sometimes be visible at the time of birth or in early infancy but most of the times it is not seen until later years in an individual’s life. These dermoid cysts are most of the times found on the head, neck or face. They are usually present on the face near the eyebrow region, on the chest just over the collarbone or on the scalp. But, these cysts can be found anywhere on the human body. Dermoid cysts are not self-treatable or curable and do not tend to go away by themselves and need to be removed by a doctor because they might become infected or might become bigger with passing time.

Dermoid cysts are not fast growing and grow slowly, as they grow they contain more mature tissues. These cysts are not of a tender nature unless they are ruptured. These dermoid cysts are most often always benign. There are rare cases when the dermoid cyst might be malignant in which case a squamous cell carcinoma tends to develop in adults whereas an endodermal sinus tumour is seen in infants and children in case there is a malignant condition. If there are superficial dermoid cysts present on the face, they can usually be removed without any complications. But, in the case of the development of some rare dermoid cysts, particular techniques have to be used.

Location of dermoid cysts

A dermoid can be found anywhere where a teratoma can occur. Some areas where the dermoid cysts might occur are:

Vaginal and Ovarian Dermoid cysts:

Structures that resemble cysts grow on the ovaries every month. These structures are called follicles. After the release of an egg from the ovaries during ovulation, these follicles deflate. Sometimes, fluid might accumulate inside the follicles which might lead to the formation of a simple cyst which resolves spontaneously without any external help. The cysts in the ovaries can be of varying sizes, from small to very large. These cysts originate from cells that are present at birth and go on to develop the characteristics of mature dermal cells. Some complications like infections, ruptures and twisting might be possible but the possibility of these happening is extremely rare. In case cyst present in the ovaries is large, it might present complications and might have to be removed through laparoscopy or laparotomy. Development of a dermoid cyst in the vagina is very rare.

Periorbital dermoid cyst:

In young children, dermoid cysts often appear in proximity to the lateral aspect of the eyebrows, which means appearing on the right side of the right eyebrow or on the left side of the left eyebrow. If the risk associated with these cysts is large, these can be excised and if there is no apparent risk, the cysts can be kept under observation. In some cases, when the dermoid cyst is disrupted it might lead to the occurrence of an inflammatory reaction. In case a cyst is not completely excised, it can also recur. A complete excision of the cyst might not be practical and possible if the cyst is in the shape of a dumbbell which means that it is extending through a suture line in the skull. The dermoid cysts form during pregnancy. These occur because of the trapping of skin cells and other substances like hair, fatty tissue, sweat glands and oil glands during the growth of the baby in the womb. These cysts are mostly present at birth and are a very common condition. But, it might be noticed months or years later as they grow at a slow pace. The symptoms and signs are usually minor and these cysts are without pain. They are not harmful generally. In case a cyst becomes infected, it should be treated properly and the cyst should be removed. Scars can develop if the removal of the cyst happens after it becomes infected.

Spinal dermoid cysts:

Then occurrence of this type of cysts is extremely rare. These cysts generally involve the lumbosacral region other than the thoracic vertebrae and present extramedullary during the first decade of life. Acquired dermoid cysts occur because of the implantation of the epidermal tissue into the spinal cutaneous inclusion which might happen during surgical procedures. Congenital dermoid cysts develop because of cells that are at the correct position but did not differentiate into the proper cell type.

Dermoid cysts in nasal sinuses:

The occurrence of this type of dermoid cysts is extremely rare. The removal of this kind of cysts is very complicated. Very few cases of this condition are reported annually.

Dermoid cysts in the brain:

Dermoid cysts occur very rarely in the brain. In case of the presence of a dermoid cyst in the brain, a neurosurgeon needs to be consulted for the removal of the cyst in case the cysts are causing problems.

Symptoms and signs of Dermoid cysts

There are no signs or symptoms caused by small or minor cysts. But, many times the cysts are felt as bumps or lumps in the skin or below the skin in the tissues. These cysts can be very painful. When these cysts rupture they can cause inflammation which requires medical attention and treatment. Bursting of these cysts can also cause infections which can further result in high fever. The cysts can become large and block the normal flow of fluids in tissues in organs like the pancreas, liver or other organs. This can result in the appearance of symptoms related to various other organs. Dermoid cysts rarely occur in the brain but can cause a lot of problems if they occur. Dermoid cysts in the spinal cord can cause infections. Dermoid cysts in the ovary can cause infections, torsion, rupture and even cancer. Basically, all types of severe dermoid cysts can result in infections and other major problems if not treated in a timely manner. Dermoid cysts are usually not a big issue but sometimes they can be a cause for concern as they cause a lot of pain and discomfort to the patient by inflammation or resulting in a fever.

Causes of Dermoid cysts

Dermoid cysts take place during pregnancy. They develop when hair follicles, skin cells, oil glands, sweat glands or fatty tissues get stuck in the skin of the baby during their foetal growth in the womb of the mother. Dermoid cysts are very common and are present at the time of birth. The cysts grow slowly and are very hard to notice on a child. Dermoid cysts are genetic conditions and cannot be prevented. Tumours in the body can also result in dermoid cysts on various parts of the body. Ducts of the body that transport fluids, food and other components getting blocked can result in dermoid cysts. Injuries severe or not severe can also result in the cysts on the skin. Inflammatory conditions which are chronic in nature can cause dermoid cysts very frequently on the patient’s body. Bacterial infections and fungal infections can also be the cause for dermoid cysts. Defects in the skin cells or defects in the tissues under the skin can also cause dermoid cysts. Infestation of parasites in the body can also cause dermoid cysts on the skin or other parts of the body such as the ovaries in the female patients.

Diagnosis of Dermoid cysts

The doctors who treat the dermoid cysts depend on the type of dermoid cysts and the problems caused by it. Going to your family doctor is always the first step towards the diagnosis. Consulting with your family doctor first is always necessary. They help you determine if a medical treatment is required or not. Small cysts that result in no symptoms do not need any medical attention. But, if there is a huge dermoid cyst in the nasal sinuses or any other part, specialists in the field of the part might also be involved. Such as neurologists may be involved in the case of a dermoid cyst in the brain. The neurologist will perform a surgery to remove the cyst before it causes any infection or damage. The doctors will run a medical history check on you and your family, conduct physical exams and ask you questions such as how long the cyst has existed and how painful it is, to determine the right treatment and diagnosis for you. Imaging studies including X-rays of the parts computed tomography (CT) scan and magnetic resonance imaging (MRI) scan may also be conducted as well to locate the dermoid cyst in the organs of the patient correctly. A biopsy may also be used to decrease the size of the cysts. An individual should go to the doctor if a cyst becomes inflamed and painful, a cyst grows in size and changes colour or if the removal of a cyst is required for any cosmetic reason. Removing a cyst is not really required in most cases. But, if the bursting of a cyst causes inflammation or results in a fever, the individual should seek quick medical attention.

Treatment of Dermoid cysts

There is no way to prevent dermoid cysts from occurring as they are genetic in nature. In normal cases, home remedies for dermoid cysts are followed such applying creams and other over the counter medications. Although, it is advised by the doctors to avoid self-removal of cysts as the dermoid cysts may grow back. The dermoid cysts grow back because of incomplete removal. People who remove dermoid cysts without any professional help have higher chances of getting infections, bleeding from the cysts and many other complications. The most common treatment for the dermoid cysts is to get it removed by the specialists. As it is hard to differentiate a normal cyst from other serious skin conditions by the patient without help. The doctors might also perform surgery to remove the cyst from different parts. The doctors will clean the area where the cyst is located and inject the patient with a local anaesthetic. Then the doctor will cut the cyst or make an incision over the cyst to drain it. The doctors will then attempt to remove it completely. It is very hard to treat a cyst in the brain or the nasal sinuses. The procedures are complicated and usually result in incomplete removal. But, dermoid cysts rarely occur in the brain or the nasal sinuses. Removal of cysts usually ends up with a complete recovery.

Complications

There are many complications and risks involved with dermoid cysts such as inflammation when they rupture. Bursting of a cyst can also result in infections which can further result in a fever. If the dermoid cysts get too big they can block the flow of fluid in the tissues of various organs such as pancreas, liver and other internal organs. There are also many complications involved with the surgery performed to remove the dermoid cysts such as infection, inflammation and sometimes the incomplete removal resulting in the cysts reappearing in the area.

Last updated on : 14-09-2018

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