Inflamed cyst AND back blackheads aka Favre racouchot

This patient has an epidermoid cyst 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.

A blackhead is also called an open comedo (single for comedone), and it is a clogged pore in the skin that is open to the air. Keratin (skin protein) and sebum (oil) combine to block the pore. They are often found on the face and trunk. but they can be found anywhere on the body. Blackheads are not clogged with dirt, but it is the exposure to air that causes oxidation turning the internal contents black. They can be extracted using a comedone extractor. I usually use an 11 blade (a blade that comes to a sharp point) and a Shaumberg type comedone extractor.
Comedones can also occur due to excessive and cumulative sun exposure to the skin, which is why you can see them on the face of older people who don’t have active acne. When the comedones are distributed around the eyes and the upper cheekbone area, it’s called Favre-Racouchot syndrome.

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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.

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