Changes can occur in the sebaceous glands of our skin, leading to different manifestations. Depending on the specific change, tiny, hard milia may form or soft, tennis ball-sized atheromas (sebaceous cysts) can develop.
Milia
Milia, also called milk spots or keratin-filled cysts, are small white cysts that often appear on the face but can also occur anywhere on the body, including the intimate areas. They generally feel hard and are typically white when they emerge on the skin’s surface. Sometimes, milia are covered by skin, making it unclear whether it’s a milium or another skin condition.
How Do Milia Form?
Milia are small cysts that form at the openings of sebaceous glands. However, unlike sebaceous cysts, milia consist of solid keratin material rather than sebum.
Are Milia Dangerous?
Milia are not a skin disease but rather a harmless skin condition. They cannot become malignant or inflamed. Nevertheless, they can be bothersome as a cosmetic concern.
How Are Milia Treated?
Treatment involves opening the milia with a surgical instrument and removing the keratin plug. The skin is typically warmed and softened beforehand.
Milia cannot be removed without opening the skin. Attempts to squeeze them out are usually unsuccessful, painful, and may lead to scarring.
Atheroma, Sebaceous Cyst, Sebaceous Gland Cyst (Sebaceous Nodule)
An atheroma, also known as a sebaceous cyst, follicular cyst, trichilemmal cyst, or epidermoid cyst, is a benign cyst that forms a half-spherical bulge on the skin. It consists of a capsule filled with sebum, skin cells, and hair cells. This capsule appears as a slowly growing, firm-elastic nodule.
Where Do Atheromas Form?
Atheromas develop in the hair follicle regions and often appear on the scalp, face, neck, behind the ears, and on the chest, abdomen, or intimate areas. When multiple atheromas occur simultaneously, they may group together. Atheromas can grow to the size of a chicken egg, and in rare cases, reach tennis ball or apple size. Large atheromas stretch the overlying skin, causing hair in that area to spread apart or disappear entirely.
How Do Atheromas Form?
Atheromas form in the area of a hair follicle. They originate from the narrow canal where the hair root resides beneath the skin. Each hair follicle has a sebaceous gland that produces an oily secretion to coat the hair. When the sebaceous duct becomes blocked—possibly by small fat crystals or skin cells—the sebum accumulates. As the sebaceous gland continues producing sebum, the hair follicle inflates into a round capsule. The resulting cavity fills with a foul-smelling whitish-gray or yellowish mass of sebum, skin, and hair cells. If infected, the mass may also contain blood and pus.
Why Do Atheromas Form?
The exact reason why some people are predisposed to atheromas is unclear, but it is believed to have a genetic basis. Preventing their formation is generally not possible. Attempts to squeeze atheromas can cause inflammation, so this should be avoided.
Careful skin care, especially in hairy and oily skin regions, may help avoid complications. If an atheroma grows significantly or shows signs of inflammation, consulting a dermatologist is advised.
Symptoms of an Infected Atheroma
- Pus formation
- Redness and warmth
- Painful swelling
- Tension sensations in the affected area
- The skin over the atheroma may appear thin yet elastic, with a black or gray point visible at the surface.
While atheromas are usually skin-colored and painless when not infected, their prominence may make them cosmetically undesirable.
Are Atheromas Dangerous?
Atheromas themselves are harmless. However, a dermatologist should examine them as some rare, more serious skin conditions may resemble atheromas. Infections can occur, causing redness, severe pain, and pus formation. If untreated, an infection can spread through the skin. Prompt removal is necessary in such cases.
How Are Atheromas Treated?
- Small, non-bothersome atheromas may not require treatment.
- If symptoms such as pain, infection, or uncertainty about malignancy arise, surgical removal is recommended.
- Removal should be thorough to prevent recurrence. Incomplete removal can lead to new cysts.
- Infected cysts may require antibiotics to prevent the infection from spreading to healthy tissue.
Self-removal is not advised as squeezing the contents may lead to bacterial infections.