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Dr. Mark
Dr. Mark, Doctor (other than dermatologist)
Category: Dermatology
Satisfied Customers: 7880
Experience:  30 years of primary care medicine
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Second opinion] Dear Sirs, On Wednesday evening I felt a

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second opinion] Dear Sirs,On Wednesday evening I felt a sharp pain on the right side of my torso; on the bra line between the axilla line and the right breast.I had two scans yesterday. The first scan was to see the lump only; the sonographer was unsure as to whether it was an abscess or a sebaceous cyst. The subsequent report then stated that it is an abscess.The second scan included a full breast scan and again a scan of the lump. This sonographer is however absolutely certain that I have a sebaceous cyst. Also when requesting confirmation, having seen the first sonographer’s report, she maintains that this is a cyst.My GP however thinks I should not drain/ operate/excise the cyst, but take a course of antibiotics. The sonographer however thought it should be drained.So my question really is; who is right? can you establish whether this is an abscess or a cyst? It does hurt but there are no lesions on the skin. It started of by not being noticeable on Wednesday night but I then started prodding and touching it so it got red and the next day on Thursday there was a noticeable ‘red’ area.If it is either, could it just go away on its own? Would it not be better to just drain it? Is there a cream etc that could be used?I am confused as to the different views!Many thanks,
Julia
Hi. I’m Dr.Mark. I’m a board certified physician. Happy to assist you. Give me a bit of time to look at the reports.
A sebaceous cyst is a fluid collection under the skin that’s from a clogged sweat gland or hair follicle. Initially these cysts are filled with sweat and oils and clear fluid. Over time they frequently become infected then fill up with pus. The ultrasound clearly shows a moderate size cyst. There is some suggestion that there may be pus inside the cyst. That’s based on some of the echo findings. But an ultrasound can’t fully tell if the cyst is full of pus. Regardless, a large cyst , whether infected or not, is best treated with drainage.
Customer: replied 14 days ago.
Would you say that this looks more like a cyst or an abscess? My GP wants to first start with a course of antibiotics to see if it goes away? Is that even possible?
It’s nearly impossible to distinguish a pure cyst from an abscess based on ultrasound alone. Usually a sebaceous cyst has some pus in it. The quickest resolution is with drainage. That can be done in the office or by the radiologist under ultrasound guidance. It’s worth while trying a course of antibiotics but that will not get rid of a pure cyst. If there’s pus in the cyst then drainage either by needle or spontaneously has to occur.
You can try antibiotics and hot soaks for a while and see if it drains. If it doesn’t resolve then it needs to be drained. My approach is that the larger the cyst or abscess the sooner I choose drainage.
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Customer: replied 14 days ago.
Ok thank you so very much! You sound the most convincing of the different approaches I have been told by my doctors! I will go to a dermatologist and book a drainage! Thank you so much!
You’re welcome. Glad to have helped. Let me know if you have further questions. Take care.