This is often due to infection. Like other epidermal associated cysts, they can become infected and when they do they will increase in size, become painful, red and often have foul smelling drainage. When treated with antibiotics and drainage, then they will shrink back down at which time resection is recommended. Surgical resection and reconstruction is usually avoided when acutely infected as it will require larger resection area and make outcomes less optimal. Dr. Som will work with you to optimize your outcomes and results based upon your presentation, often times starting out with oral antibiotic to treat any acute infections and then plan surgery when improved to optimize the best aesthetic outcome and hasten your recovery.