Skin

Trichilemmal cyst

This article was last reviewed and updated on May 14, 2019

by Pavandeep Gill, MD and Allison Osmond, MD FRCPC

Quick facts:

  • A trichilemmal cyst is a non-cancerous growth that starts in a hair follicle.
  • It is a very common condition and most start on the scalp.
  • Another name for trichilemmal cyst is a pilar cyst.

Normal skin
The outside of our body is covered in skin. The surface of the skin is called the epidermis. The epidermis is made up of keratinocytes which produce a material called keratin. The epidermis is waterproof and protects us from toxins and injuries.

Below the epidermis is a layer called the dermis. The dermis contains important structures such as hair follicles, sweat glands, nerves, and blood vessels.

The hair follicles in our skin make hair. The follicle begins at the surface of the epidermis and is divided into different segments as it extends deep into the dermis. The parts of the follicle include the infundibulum, isthmus, and hair bulb.

What is a trichilemmal cyst?

A trichilemmal cyst is a non-cancerous growth that starts in the hair follicle. They are very common and most start on the scalp where they look like a smooth, round bump on the skin. Trichilemmal cysts range in size from a few millimeters to several centimeters.

Another name for a trichilemmal cyst is a pilar cyst.

When viewed through the microscope, most trichilemmal cysts are filled with compact, ‘wet’ looking keratin. The keratin is surrounded by a layer of flattened keratinocytes without the usual granular layer.

Trichilemmal cysts can rupture which means they break open and spill their keratin into the surrounding normal tissue. When this happens, your pathologist may see a large number of immune cells surrounding the cyst. Your pathologist will examine your tissue carefully to make sure there is no sign of cancer.

The diagnosis of trichilemmal cyst may be made after a small sample of tissue is removed in a procedure called a biopsy. The diagnosis can also be made after the entire cyst is removed and sent to a pathologist for examination. No further treatment is usually required after the entire cyst has been removed.

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