American Academy of Dermatology

View all recommendations from this society

Released August 19, 2015; Updated October 18, 2021

Don’t routinely prescribe antibiotics for inflamed epidermal cysts.

The overwhelming majority of red and swollen epidermal cysts (ECs) are inflamed but not infected. It is important to confirm infection before treating these cysts with antibiotics. Appropriate treatments for inflamed ECs include incision and drainage or an injection of corticosteroid directly into the cyst.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Dermatology (AAD) is strongly committed to dermatologists serving as effective stewards of limited health care resources by assisting patients in making informed health care decisions. As such, the AAD leadership created a workgroup to develop this list with specific skills and expertise in evidence based research, public health quality and payer policy. Members of this workgroup include dermatologists who are current members of the Academy’s Board of Directors, Council on Science and Research, Council on Government Affairs, Health Policy and Practice, Research Agenda Committee, Clinical Guidelines Committee, Access to Dermatology Care Committee, Patient Safety and Quality Committee, Resource-Based Relative Value Scale Committee and the Workgroup on Innovative Payment Delivery. The workgroup identified areas to be included on this list based on the greatest potential for overuse/misuse, quality improvement and availability of strong evidence based research as defined by the recommended criteria listed below. The recommended list was reviewed and approved by the AAD Council on Science and Research and the AAD Board of Directors.

  • Supported by available scientific evidence (e.g., existing AAD appropriate use criteria and/or existing AAD clinical guidelines)
  • Strongest consensus inappropriate score from the AAD Appropriate Use Criteria (AUC)
  • Strong (wording/level of evidence) recommendations from the guidelines about discouraged practice
  • Greatest potential for improvement in outcomes for patients
  • Greatest potential for overuse/misuse by physicians

AAD’s disclosure and conflict of interest policy can be found at


Diven DG, Dozier SE, Meyer DJ , Smith EB. Bacteriology of inflamed and uninflamed epidermal inclusion cysts. Arch Dermatol 1998;134:49-51.

Stevens DL et al (Clin Infect Dis 2014; 59:147-59). Clin Infect Dis. 2015;60(9):1448. doi:10.1093/cid/civ114