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Sebaceous Cyst Removal

In this video Dr. Nakatsui is removing two sebaceous cysts located on the scalp. Our lovely patient graciously allowed us to film the procedure and we thank you for that!

In this video the two cysts come out relatively easily and intact as a whole. There will be several instances where we are not so lucky and the cyst may fragment or it may adhere to surrounding tissue more making extraction more difficult.

Sebaceous cysts may occur anywhere on the body at any time of our lives. They are generally not life-threatening, but when concerned about any lesion, it is always best to seek medical attention. Many patients with sebaceous cysts may leave them as they generally will not bother them. From time to time, cysts may become inflamed, painful, produce discharge, or become infected. If a cyst has had repeated infection/inflammation or self attempts to extract the contents by squeezing the cyst, this is when the cyst wall may become more adherent to surrounding tissue making it difficult to extract.

Should a cyst develop, it is advisable not to perform self surgery as any tools used to puncture the skin or extract the cyst may push unwanted bacteria into the site causing an infection. Not only that, if the wound site is not properly closed or should become infected, when it fully heals you may be left with an unwanted scar which may be difficult to treat in the future.

Nanosecond pulsed electric field treatment of sebaceous hyperplasia

At Nakatsui DermaSurgery, sebaceous hyperplasia are most commonly treated with the CO2 resurfacing laser. A recent study on a new treatment modality was published in Dermatologic Surgery on the use of nanosecond pulsed electric field therapy. Each sebaceous hyperplasia lesion was treated 1-2 times. Ninety percent of lesions cleared with electric field therapy. With respect to pain, 54% reported mild pain, whereas 15% reported moderate pain with treatment Patients did experience hyperpigmentation although this gradually faded with time. At day 60, 45% of lesions were hyperpigmented. Redness and swelling were noted initially but did nor persist. One of the persistent side effects was that of small depressions at 19% of treatment sites.

This is an interesting new technique for treatment of sebaceous hyperplasia. Whether it will replace the use of CO2 resurfacing remains to be seen. Find out more about sebaceous hyperplasia.

Reference

Safety and Efficacy of Nanosecond Pulsed Electric Field Treatment of Sebaceous Gland Hyperplasia. Munavalli GS, Zelickson BD, Selim MM, Kilmer SL, Rohrer TE, Newman J, Jauregui L, Knape WA, Ebbers E, Uecker D, Nuccitelli R. Dermatol Surg. 2020 Jun;46(6):803-809.

Clean Cyst Removal

Sebaceous Cyst Removal

In this video, Dr. Nakatsui removes a sebaceous cyst from our patient’s scalp. The cyst came out whole, cleanly, and intact! Many times, if a cyst becomes infected it can adhere to the surrounding tissue making extraction trickier as it can fragment and stick to surrounding tissue.

Overall a great little surgery which great end results!

Benign Cysts and Growths

skin tags and other benign lesions (cysts, seborrheic keratoses, and sebaceous hyperplasia, milia)

Skin tags, sebaceous hyperplasia, seborrheic keratoses, milia, sebaceous cysts, and syringomas are a few of the very common benign growths that people get as they age.

Seborrheic Keratoses sebaceous hyperplasia skin tags milia sebaceous cysts syringomas

Our skin is the largest organ of the body and is subjected to many internal and external abuses. So it is not surprising that over time the skin develops a variety of innocent lumps and bumps, some of which may be cysts and growths. These lumps and bumps are many and varied, and are often tagged with long medical names that are impossible to pronounce. Suffice it to say that you do not have to live with white, brown, or red appendages that may protrude from your skin. They are usually easy to remove, particularly now that target specific lasers have been developed. Common benign lesions that are not pre-cancerous or cancerous may include: acrochordons (skin tags), milia, seborrheic keratoses, syringomas, sebaceous cysts, and sebaceous hyperplasia.

Benign cysts and growths such as skin tags and seborrheic keratoses are considered to be cosmetic in nature therefore removal of these lesions is the responsibility of the patient. The cost varies on the type of lesion, the number of lesions, and the treatment recommended.

Frequently Asked Questions (FAQ) About Milia, Syringomas, and Sebaceous Cysts

What Are Milia?

Milia are common, harmless, miniature oil gland cysts which can appear anytime during life. They may occur when the pores become plugged with creams, but may also occur on their own.

Milia never become malignant. They can become larger, and sometime become annoying because of their cosmetic appearance, but do not present any concern medically.

How Are Milia Treated?

Milia are usually removed with gentle electrodesiccation or, in the case of larger lesions; they are vaporized with the carbon dioxide laser. To prevent milia avoid the use heavy creams which plug up the pores.

What Are Syringomas?

Syringomas are benign tumors of the sweat ducts, which appear most commonly on the neck, chest and face, particularly under the eyes. They may vary in color from translucent or skin colored, through the yellow spectrum, to a purplish shade. They may be round or flat, and can range in size from 1 to 5 mm. Syringomas commonly appear during adolescent and may increase in number into adulthood.

How Are Syringomas Treated?

Excision was the treatment of choice in the past, although a small scar was unavoidable. Now syringomas can be easily vaporized with a CO2 laser. To avoid a dent in the skin, the cyst is not always entirely removed; therefore recurrence is common. Asymptomatic in nature, they are usually removed for cosmetic reasons.

What Are Sebaceous Cysts?

A sebaceous cyst forms when an oil gland ruptures in the second layer of the skin and becomes surrounded by scar tissue. These dome-shaped protuberances commonly appear in groups on the skin but may be solitary. They enlarge slowly and may become inflamed and tender from time to time.

Pilar cysts are similar to sebaceous cysts. They appear in multiples on the scalp and are common in families.

How Are Sebaceous Cysts Treated?

Cysts are usually excised with or without CO2 laser surgery. The cyst is anesthetized prior to removal so no pain is felt during the procedure. Once the treatment is complete the treatment site may be swollen, bruised and tender to the touch for several days.

Do you have another question that wasn’t addressed here? Please feel free to contact us with any questions or concerns you may have!

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CellFX

CellFX is a brand new technology for the treatment of a variety of skin lesions, including warts, sebaceous hyperplasia, dermatofibromas, and seborrheic keratoses.

Nakatsui DermaSurgery was one of only five sites in Canada selected in 2021 to use this first of its kind technology.

cellfx nano pulse stimulation electricity

It is a brand new technology in that it uses billionths of a second pulses of electricity to disrupt cellular structure and get rid of benign and malignant skin lesions. Just as we have harnessed the power of lasers by decreasing the pulse width of laser pulses from microseconds to nanoseconds to picoseconds and made them safer, CellFX now does the same thing for electricity.

Whereas you might think electricity is dangerous (and it is), CellFX harnesses the power of electricity so that is can be delivered in billionths of a second pulses. Amazing technology!

cellfx wart treatment being administered

The most unique thing about CellFX is that it produces no heat, unlike laser and radiofrequency. It actually disrupts the cell membranes where it is being administered but leaves the surrounding scaffolding of the skin (e.g. collagen) untouched, which reduces the risk of scarring. Traditional technologies like liquid nitrogen and electrocautery can often result in unnecessary destruction of surrounding dermal tissue.

What kinds of Skin Problems Can be treated with the CellFX Procedure?

Currently, this technology is being used in the treatment of common warts, sebaceous hyperplasia, and seborrheic keratoses. We have had some amazing results in many patients for these problems. It is also being actively investigated for the management of dermatofibromas, acne, cherry angiomas, syringomas, moles, oily skin, and basal cell carcinoma. Other potential uses also exist although these are still being investigated.

Sebaceous Hyperplasia

Common Warts*

*Does not include genital warts

Seborrheic Keratosis

How does the CellFX procedure work?

CellFX uses an innovative technology that uses ultrafast (billionths of a second) electrical energy pulses to alter cells in the treatment zone, stimulating a gradual clearing of the cells that lead to the regeneration of new cells while keeping the healthy collagen foundation unharmed.

RESOLVES
Naturally clears spots and bumps, leaving surrounding collagen unharmed

REGENERATES
Stimulates cell turnover, replacing affected cells with healthy new cells

RENEWS
Renews the skin surface for a natural, healthy appearance

“We are delighted to be on the forefront with this technology and it’s just the beginning.”
– Michelle Juneau. MD, Dermatology Consultants, Atlanta GA

Frequently Asked Questions about CellFX

Can multiple lesions be treated in one procedure?

Yes, multiple lesions and lesion types may be treated in one session. Frequently, patients have multiple warts on the hands or feet, or multiple sebaceous hyperplasias on the forehead and they can all be treated in one session. Since each lesion can be treated in a matter of seconds, it’s easy and practical to have multiple lesions treated in a single treatment session.

How long does the CellFX procedure take?

A typical procedure involves photographs of the target lesion(s) , infiltration of local anesthetic, followed by the actual treatment. The actual time of the session is typically 15-30 minutes depending on the number of lesions to be treated. Treatment of each lesion usually requires only 10-15 seconds of pulsing.

How soon can I return to normal activity?

Generally, most patients can immediately return to normal activity. Simple wound care will be recommended by your physician, such as wearing a small bandage for a short amount of time.

How is the CellFX procedure different from other ways to clear lesions?

The most important difference with the CellFX procedure is that unlike laser, radiofrequency, surgery, cold, heat, and electrocautery, it affects cells and only cells. This means it can clear the cells of the lesion without affecting the surrounding non-cellular skin tissue (e.g.collagen).

The technology behind this procedure is called Nano-Pulse Stimulation™ (NPS™). NPS technology uses non-thermal energy, which means it does not generate heat or cold. Other methods such as burning, freezing, or cutting involve unnecessary destruction of surrounding skin tissue, which can lead to a greater risk of scar or other permanent undesired effects.

The ability to affect only cells using a non-thermal energy provides your doctor unique control in clearing the lesion. All these beneficial differences can help minimize the risk of scarring, lessen the chance of lesion recurrence and support a more natural, gradual healing process.

How many visits are needed?

The number of sessions you may need is related to the type of lesion, locations of lesion, skin type, and expectations on the healing process. Larger, deeper lesions may require more than one procedure session, whereas smaller lesions may be able to clear with a single procedure session. Most sebaceous hyperplasia clear with one session but warts may require a few sessions to clear, although they sometimes disappear with one session.

Are there any side effects with the CellFX procedure?

In clinical studies, no serious side effects have been reported.

How much does a CellFX procedure cost?

The CellFX procedure is not covered by Alberta Health and is a cash-pay procedure. The cost will vary based on the number of lesions. Consult us for more detailed information.

Before and After Photographs of CellFX

Sebaceous Hyperplasia

Common Warts*

finger wart before cellfx treatment — Before

wart treatment after CellFX Edmonton — Before

Seborrheic Keratosis

Call us today at 780-482-1414 to schedule your consultation
or contact us online to find out if CellFX is right for you!

Acne

Acne vulgaris is an extremely common condition that affects teenagers, adults, and sometimes even infants (baby acne). Although this condition is most common in teenagers, it can appear in adults as well, especially in women along the jawline.

It is characterized by different types of blemishes like papules, pustules (pimples), comedones (whiteheads and blackheads), and sometimes cysts. It can also occur on the back (back acne or “bacne”) or chest.

Cystic acne is one of the more severe forms as it is the most likely to leave permanent scars. Cystic acne often means that more aggressive treatment like Accutane is warranted and that laser treatment may be needed to address acne scars. Learn more about the different types of acne scar treatments.

Typical areas of involvement are the face (forehead, chin, cheeks, and nose), chest, back, and arms. Although extremely common, even mild cases can be unsightly and can be damaging to one’s self-esteem and emotional well-being. The most troublesome aspect of this condition is the potential for scars to occur, especially with cystic acne, as this can be extremely difficult to treat in some cases. Our dermatologist-led Edmonton acne clinic can address your pimples and blackheads, as well as acne scarring.

What causes acne?

This condition is caused in part by a bacteria called Cutibacterium acnes (previously called Propionibacterium acnes). This bacteria helps to clog pores leading to an accumulation of sebum, which in turn causes inflammation. Other factors such as makeup, stress, heredity, diet, lifestyle, friction, and hormones can also contribute to clogging your pores.

Who gets acne?

80% of adolescents
25% of adults aged 20-40
75% of adult cases are in women (likely because of hormones)

Treatments For Active Acne

How to get rid of acne

Getting rid of acne is not always easy. Treatment can be broken down into internal treatments and external treatments. Internal treatments include medications such as oral antibiotics, birth control pills. and Accutane, while external treatments include topical antibiotics, laser, Morpheus8 RF microneedling, Isolaz, and photodynamic therapy (PDT).

At our dermatoloigst-led Edmonton acne clinic, we first treat patients with active acne using a step-wise approach, depending on severity. If mild, we can start with a topical antibiotic, or a topical retinoid like tretinoin if the patient has comedones (whiteheads and blackheads). Some examples of commonly used topical medications include Tactupump Forte and Biacna. If more severe, we can use oral antibiotics like tetracycline, doxycycline, minocycline, and erythromycin, or birth control in women. Some women will respond to medications that block the testosterone receptor such as spironolactone. Some other popular treatments include chemical peels, HydraFacial MD, blue light, radiofrequency microneedling (Morpheus8), or laser.

If you just have one spot, our doctors can do a spot treatment with a tiny injection of cortisone to clear that spot in many cases. However, care must be taken to avoid injecting too much cortisone to avoid indenting the skin.

If very severe (e.g. cystic acne), we will often use Accutane, Clarus, or a new version called Epuris. Epuris, Clarus, and Accutane are very similar as the active ingredient in all of these is isotretinoin, but Epuris has one major advantage–it can be absorbed without taking it with a fatty meal (which is the ideal way to take Accutane). The problem with Accutane and Epuris is that they have a list of potentially significant side effects, which include birth defects, extreme dryness, elevated cholesterol and triglyceride levels, and depression. Despite theses risks, it is often prescribed for persistent cases and for cystic acne.

Other treatment options for active acne

Fractora is a fractionated radiofrequency (RF microneedling) treatment that our dermatologist uses to help decrease acne and help treat scars as well. This treatment uses radiofrequency to reduce sebum production.
Morpheus8 is our newest treatment for acne. It is the new, improved version of Fractora, yielding even better results with less discomfort. It reduces sebum production and kills the causative bacteria. As a side benefit, it also helps with acne scarring.
Chemical Peels can be used in some patients. The exfoliation caused by the chemical peel would frequently improve the condition although there are some patients whose skin condition worsens as a result of irritation. Discuss this with Dr. Smith or Dr. Nakatsui before proceeding with therapy.
HydraFacial MD treatments can also help. It simultaneously exfoliates, removes impurities, and rehydrates your skin. We have had a lot of success using this modality.
Isolaz is a device that uses a combination of suction and light therapy to kill acne bacteria and clear pores. This is not strictly speaking laser treatment as it uses intense pulsed light to treat the skin. This decreases the number of lesions and the amount of sebum produced. We did use this on our patients for awhile and found it effective for some people. Although Isolaz can be effective, we no longer offer this therapy because we were not able to sterilize the tips between use and if we used new tips for every treatment, it made treatments too expensive for the patient.
PDT is an effective therapy that uses a special wavelength of light to activate a topical medication that is absorbed by acne-causing bacteria to clear the bacteria and treat the acne. One of the downsides of PDT therapy is that it may cause redness and peeling, which could last up to one week following therapy.
Pulsed dye laser can sometimes be used to treat acne. It works through photochemical effects on Cutibacterium acnes and photomechanical effects on sebaceous glands and microvasculature.

Acne can also leave unsightly scarring. Fortunately, there are many treatments available to treat acne scarring at Nakatsui Dermasurgery (formerly Groot DermaSurgery). Learn more about your scar treatment options here.

Acne Treatments

Morpheus8 HydraFacial MD Photodynamic therapy

Frequently Asked Questions

What is Maskne?

Maskne is a colloquial term for the development of acne in areas covered by a mask. This has become very common with face mask precautions during the Covid-19 Coronavirus pandemic. Many people are suffering from pimples developing under the areas covered by their mask.

In some people, this represents a type of acne mechanica where rubbing stimulated the development of pimples. Athletes often see this in areas of rubbing such as with chinstraps. This same process can affect mask wearers. In others, the acne-like outbreak is probably perioral dermatitis bought on by irritation from the mask.

Perioral dermatitis is a condition where blemishes develop as a result of skin irritation. As a result, people with sensitive skin are more likely to develop this. This irritation can cause similar rashes around the nose (perinasal dermatitis) and around the eyes (periorbital dermatitis). Treatment for this involves removing the irritants and may involve the use of oral and topical antibiotics. With maskne and COVID, it will be impossible to eliminate the use of masks but using a mask that is clean and less abrasive will help.

Is Accutane Use for Acne Associated With Inflammatory Bowel Disease?

The potential association between isotretinoin use (such as Accutane, Clarus, or Epuris) for acne and inflammatory bowel disease (IBD) such as ulcerative colitis and Crohn’s disease is controversial. Some studies have suggested there may be an association whereas others have concluded there is no association.

One of the most recent studies was published in 2021 and looked at 27230 patients on isotretinoin and 631089 control patients who were not on isotretinoin. The researchers found the incidence of IBD in patients exposed to isotretinoin was very low and they could not find any evidence of increased risk versus the control population. At this point, the risk of developing IBD from isotretinoin appears to be very low if it there is even a true association at all.