Trichilemmal Cyst

Synonyms: Kista pilaris, sebaceous cysts.

Definition: trichilemmal cyst is a cyst containing keratin, composed by an epithelium that resembles the outer root sheath of hair, can be derived autosomal dominant

Epidemiology: Usually appears in middle age. Women are more often affected than men.

Etiology: Wall cysts originating from outside the hair root sheath that surrounds the bottom of the hair follicle.

Manifesasi Clinic: basanya occurs on the scalp. Clinically difficult to distinguish from epidermal cysts, but these cysts dienukleasi easier and more keratinosa contents and not so fatty and less smelly than the content of epidermal cysts.

Histopathology: Looks restricted cyst wall several layers of cuboidal shaped epidermal cells are arranged palisade without granular layer and intercellular bridges. Epithelial cells bordering the cyst contents swell and contains pale cytoplasm. Cyst contents in the form of a homogeneous eosinophilic material.

Diagnosis: epidermal cysts, Cylindroma, Lipoma.

Treatment: Treatment for cysts trichilemmal is the same as epidermal cysts.

Prognosis: Good, rarely undergo malignant transformation.

Pathophysiology, Histopathology and Treatment of Epidermal cysts


Epidermal cysts occur as a result of the proliferation of epidermal cells in the dermis circumscribed space. In the analysis of epidermal cysts, lipid structure and the same pattern as in the cells of the epidermis. Epidermal cyst express cytokeratin 1 and 10. The source of the epidermis is almost always from the infundibulum of hair follicles.

Inflammatory mediated by section epdiermal keratinized cysts. In the study, the extract keratin is chemoactive for PMN.

The studies mentioned HPV (Human Papilloma Virus) and UV exposure plays a role in the formation of epidermal cyst.

How to change the epidermal cysts become cancerous is not known for certainly (though rarely epidermal cysts develop into malignant tumors). At epidermal cyst carcinoma, immunohistochemistry for HPV negative results, which can be summed HPV does not affect changes into squamous cell carcinoma. Chronic irritation and repetitive trauma to the limits of the cyst epithelium epidermis role in malignant transformation, but how to do is still unknown.


On histopathologic examination, epidermal cysts lined with stratified squamous epithelium containing granular layer. Laminated keratin found in cysts. Inflammatory responses can be found in the cysts rupture. Mature Cyst can be calcified.


Generally, epidermal cysts do not require any treatment. When the excised can cause interference, or dissection entire cyst wall with incision. When part of the wall behind, the cyst may recur. Destruction of the cyst with curettage, liquid chemical, or electrodesiccation give unsatisfactory results.

When inflammation occurs, it can be given   triamcinolone intralesional injection (amcort, aristocort) which can suppress PMN migration and make a narrow slit capillary blood vessels. Oral antibiotics are also given if necessary.


Very rare complications, including infection, scarring on removal, and recurrence. Malignancy in epidermal cysts are very rare.

Epidermoid Cysts

Epidermoid Cyst
Epidermoid Cyst


Epidermoid cysts or also called a sebaceous cyst is a collection of materials such as keratin, usually white, slippery, easily moved, and cheesy on the inside wall of the cyst. This type of cyst is the most common. Clinically, epidermal cysts appear as rounded nodules, hard-colored flesh. Epidermal cysts generally have a small hole associated with the skin but are not always apparent.
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