A "giant blackhead" on a scalp cyst is a relatively common dermatological finding. While it may appear alarming, it is typically a benign condition. This feature is often associated with a few specific types of skin lesions, most notably a dilated pore of Winer or certain kinds of cysts.
Understanding the "Blackhead"
The black appearance is not dirt but rather the result of a process called oxidation. The plug of material filling the pore or cyst opening is primarily composed of keratin (a protein that makes up skin, hair, and nails) and sebum (an oily substance produced by the skin's glands). When this material is exposed to the air, the oxygen causes it to darken, much like a cut apple turns brown.
Possible Conditions
Several conditions can present as a giant blackhead on the scalp:
Dilated Pore of Winer: This is the most common cause of what appears to be a giant blackhead. It is essentially a single, very large, open comedone (the medical term for a blackhead). The pore of a hair follicle becomes clogged with keratin and sebum, which then dilates the opening significantly. These are benign and more common in middle-aged and older individuals.
Pilar Cyst with a Central Pore: Pilar cysts are very common on the scalp, accounting for about 90% of all scalp cysts. They form from the root sheath of a hair follicle and are filled with thick, cheesy-white keratin. Sometimes, a pilar cyst may have a small opening or pore on the surface that can become plugged with oxidized keratin, giving it a blackhead-like appearance.
Epidermoid Cyst: These cysts can occur anywhere on the body, including the scalp. They are formed from epidermal cells that have become trapped under the skin. Like pilar cysts, they are filled with keratin and can sometimes have a central opening (punctum) that can appear dark.
Symptoms and Diagnosis
Aside from the visible "blackhead," these lesions are often:
Slow-growing
Painless, unless they become inflamed or infected
Firm and dome-shaped under the skin
A dermatologist can usually diagnose the condition based on a physical examination. In some cases, a biopsy may be performed to rule out other, less common skin conditions.
Treatment Options
Treatment is often not medically necessary unless the lesion is bothersome, becomes inflamed, or for cosmetic reasons. It is strongly advised not to squeeze or try to extract the contents yourself, as this can lead to inflammation, infection, and scarring.
Professional treatment options include:
Comedone Extraction: A dermatologist can use a sterile instrument to remove the keratin plug from a dilated pore of Winer. However, the pore may refill over time.
Surgical Excision: This is the most effective treatment for preventing recurrence.
For a dilated pore of Winer, the entire pore is surgically removed.
For a cyst, the entire cyst sac is removed. If the sac is not completely removed, the cyst is likely to grow back.
The procedure is typically done in an outpatient setting under local anesthesia.
When to See a Doctor
You should consult a healthcare professional if you notice:
Signs of infection, such as redness, swelling, pain, or drainage of pus
Rapid growth of the lesion
The lesion becomes tender or painful
You are concerned about its appearance
In summary, a giant "blackhead" on a scalp cyst is usually a harmless condition. However, for a proper diagnosis and to discuss treatment options, it is best to see a dermatologist.