Inflamed cysts should be treated initially with an incision and drainage technique. The region is anesthetized and then incised with a no. 11 blade. The resulting cheesy-white macerated keratin debris is removed with lateral pressure, and a curette is used to break apart internal loculations. The drainage material has a pungent odor. The resulting cyst cavity can be packed or left open until the patient returns in 2 to 3 weeks for definitive removal of the cyst lining by excision. Intralesional triamcinolone is very effective in decreasing the inflammation and pain in these inflamed cysts. Long-standing cysts should be cultured and the patient given the appropriate antibiotic therapy based on the culture results.
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