Brief: This page is about quite a rare piercing bump known as a cyst. They appear most often on cheek piercings and are quite tricky to treat successfully.
TL;DR – Too much information? For a shorter version try our quick reference guide here.
There are many different types of cysts but, usually, the type of cyst most commonly found on body piercings is known as an Epidermoid cyst. Having a cyst form near a standard body piercing is actually quite rare but these cysts can be quite common on cheek piercings and are one of the main reasons why cheek piercings are considered so different from ‘normal’ facial piercings.
Mostly cysts begin beneath the skin, sometimes with a small scab-like opening on the surface. They often feel like a hard ball under the skin that can be moved around quite easily. When the cysts develop a little bit more they often produce a small dome (rounded circle) on the top of the skin. This is usually skin coloured.
If the cyst gets infected or if it’s been irritated it can often appear quite red and sore but, more often than not, cysts tend to be fairly painless.
Cysts are often full of liquid and can sometimes pop or leak. They suffer from a few types of discharge:
- Often the discharge is thick and lumpy (like cottage cheese) and can smell a bit cheesy like old socks. This isn’t actually pus but something called keratin that is a protein which makes up skin.
- The discharge can also be a grey/green/dark yellow and smell pretty bad (often compared with vomit), which is pus and usually signals an infection.
- It can be a brownish red colour which is a mixture of discharge (or pus) and blood.
- Finally (though rarely), you may find a very oily, waxy kind of substance which looks a bit like yellow grease, it is usually odourless but it can also, sometimes, smell a little off as well. This is what is known as sebum and is responsible for keeping your skin moisturised and full of vitamins.
Epidermoid cysts are caused by epidermis cells, getting into deeper parts of the skin (where they normally don’t live). When the epidermal cells are in the deeper part of the skin instead of dying off they continue to work as they normally would and multiply.
The multiplied cells form a sac which then fills with the keratin protein that they would normally make on the surface of the skin as it has nowhere else to go. As the sac gets bigger it appears on the outside as well as inside the skin (hence the bump) and when the sac is full enough it will try to empty by popping or leaking.
The problem of epidermis cells accidently getting into deeper parts of the skin is thought to be caused by trauma or blocked glands / pores. Since cheek piercings often cause blocked saliva glands as well as trauma, it is thought this is the main reason why cysts are so common on them in particular.
Other types of cysts which could appear on a body piercing include;
- Pillar cysts which are caused by hair follicle cells getting into deeper skin (and are more common in ‘hairy’ areas of the body)
- Sebaceous cysts (known as steatocystomas) which are generally formed from blocked sebaceous glands and tend to fill with mostly sebum. ‘True sabaceous cysts’ are much rarer than pillar or epidermoid cysts and feel softer. They also tend to be more difficult to remove and only tend to appear during puberty or in the elderly.
Prevention of cysts is quite difficult since it seems to be purely down to chance whether the troublesome cells will get inside the deeper skin layer and not much research has been done into prevention itself.
You are more likely to be prone to cysts if; you are past puberty, male or have a history of acne. Some people who have had significant exposure to the sun or uv rays (i.e. tanning beds) may also find they can be more prone to them.
The best prevention, in terms of body piercing, is to avoid cheek piercings. You need to be prepared for the possibility of cysts leaving behind permanent scarring on your face, as well as the other issues they can face, if you decide to get pierced.
Cysts forming on other body piercings are rare but still possible so it is worth considering whether other piercings are worth the risk too especially if you have been prone to cysts on other wounds in the past.
Cysts can be very hard to shift because they exist so deeply in the skin. However there are a few things you can do to try and help a cyst before resorting to surgery to remove it.
The best home remedy for cysts is to encourage them to drain using a hot compress. We suggest making a saline soak (see here for instructions) as hot as you can bear without burning yourself and soaking the cyst and the piercing underneath it for several minutes. The action of the salt should help to drain the cyst alongside the action of the hot water. Perhaps more effective than a compress alone. Doing this for several minutes twice a day for a week or two should be sufficient to remove the gunk inside the cyst.
Another thing you can try a medicated or antibacterial talcum powder to help reduce the levels of harmful bacteria around the piercing and dry out the bump itself. You can often find these powders in pharmacies or online. A powder such as CX Powder is perfect.
It is important to note that you should never pop the bump with something sharp because opening the skin around something so full of bacteria and collected fluids can very easily get infected.
Generally once the gunk is gone and the cyst has dried out it will naturally disappear. However in some cases, because the cyst’s ‘sac’ hasn’t been removed, it can begin to fill up again – bringing the cyst ‘back.’ At this point it is probably best to see a doctor for professional treatment. You should also seek medical help if the cyst is very irritated or doesn’t improve after a few days treatment.
It used to be thought that a hydrogen peroxide gel would help to shrink the bump but, unfortunately, this is simply not the case as the hydrogen peroxide cannot penetrate enough to make a difference. Hydrogen peroxide is particularly damaging to healing wounds, also, and is likely to significantly interfere with a healing piercing. Doctors no longer recommend its use in wound care, it clearly states on the bottle that it is not suitable for puncture wounds and if it gets into your ear canal you can even go deaf. For your safety therefore, do not use hydrogen peroxide to treat any sort of bump.
It is important not to use home treatments as any form of substitute for proper medical advice, especially if your symptoms worry you, get worse or get no better.
If your doctor wants to try and avoid surgery at first they may suggest a steroid injection or laser therapy especially if the cyst isn’t infected. These methods help to flatten the bump and encourage it to be reabsorbed.
However, usually, the main course of treatment for a cyst is to have it surgically removed. This is done under local anesthetic and usually consists of the cyst being popped and drained and then the sac under the skin being scooped out. Sometimes, if the cyst is big enough, you may need stitches to fully close the area left behind. Cysts rarely reform after surgery because there is no sac for them to ‘fill up.’
If you would like to read more on the subject of cysts we recommend the following articles:
Skin Sight, a website specialising in dermatology and skin care, has a lot of detailed medical information about cysts found here.
This guide from patient.co.uk, a medical support site offering information and support to patients is also helpful and goes into some detail about treatment methods found here.
Anthony J Perri ,MD is a certified dermatologist and runs a blog on his website. His entry on Steatocystomas is wonderful detailed with great photographs and explanations.