What should you know about follicular cyst on scalp?

Scalp follicular cysts, also called pilar or trichilemmal cysts, commonly feel firm, smooth and mobile beneath the scalp. The overlying skin may look normal. They can catch on a comb, helmet or hairbrush, and inflammation may cause soreness, redness or swelling. A clinician should check a new, changing or uncertain scalp lump because not every lump has the same origin. The examination may include looking at nearby skin and checking whether the lump is attached to the surface or deeper tissue.

Avoid picking, cutting or puncturing the lump, even if it has a visible opening. Use gentle hair care and protect it from repeated friction. If it is not troublesome, a clinician may discuss monitoring. When it repeatedly catches, enlarges, becomes inflamed or causes discomfort, cyst removal may be considered. Ask how the procedure could affect hair around the site and how to keep the area clean while it heals.

Arrange an assessment if the lump grows, becomes fixed, bleeds, ulcerates or causes ongoing pain. Seek prompt care for spreading redness, pus, fever, marked tenderness or rapidly developing swelling. Multiple scalp lumps, or a lump accompanied by a new patch of hair loss, should also be reviewed so the diagnosis and treatment plan are clear.

Ask whether the lump fits a pilar cyst, whether monitoring is suitable, what would make removal advisable, and what scalp care is needed after treatment.