Incision & Drainage of Inflamed Cyst behind left ear

This patient was so adorable, because she is down at her family home, visiting from college in another part of the state, and she is accompanied by her mother. I asked her mom and the patient if we could film this procedure and I explained why. Her mom had never heard of Dr Pimple Popper, but she is a popaholic, for sure! Once I showed her @drpimplepopper on instagram, she didn't pay any attention to us or the procedure we were doing on her daughter. Of course, she loves her daughter, but her daughter was very comfortable during our incision and drainage procedure here. Her mom was entranced with my instagram page and she couldn't wait to show her friends. It was just so cute!Show more

This patient has an epidermoid cyst behind her left ear, which has recently become inflamed and “infected”. I put “infected” in quotes, because technically this is not an infection: When an epidermoid cyst ruptures, it creates a vigorous foreign body inflammatory response - this skin becomes warm, tender, painful, and swells, simulating an abscess. Incision and Drainage (I & D), will confirm the diagnosis of inflamed cyst, when the cheesy, sometimes odiferous material is evacuated, and this process often leads to rapid resolution of symptoms. These episodes are often misdiagnosed as “infection” of the cyst, but cultures are usually negative and antibiotic treatments is not required. Intralesional steroids can hasten the resolution of symptoms as well.

All this being said, we often prescribe antibiotics- it’s hard not to when you see something so red and inflamed and painful.. it seems almost cruel not to! Also, we as dermatologists, will just call the cyst infected, or call it an abscess. It’s more difficult to explain to patients why we would not call an area that looks angry and red and is painful non-infected. However, I felt I needed to clarify all of this in detail here, for medical education purposes!

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This video may contain dermatologic surgical and/or procedural content. The content seen in this video is provided only for medical education purposes and is not intended to be a substitute for professional medical advice, diagnosis, or treatment.