Cysts

90

Cysts

Introduction

• Variably sized papules or nodules.

• Cysts can be divided into true cysts with an epithelial lining (histologically and sometimes visible clinically) and false cysts without such a lining.

• Appreciation of the actual size of the cyst often requires palpation.

• Different types of cysts often have characteristic anatomic locations and histologic features.

• Treatment of true cysts (if symptomatic) is primarily surgical.

True Cysts – Common

Epidermoid Inclusion Cyst (EIC) (Epidermal Inclusion Cyst, ‘Sebaceous Cyst’)

• Most commonly on the face and the trunk; skin-colored to yellow-white unless inflamed; size varies from several millimeters to centimeters.

• A visible comedonal-like opening or pore (resembles a blackhead) may be seen on the surface of the papule or nodule (Fig. 90.1A).

Fig. 90.1 Epidermoid inclusion cysts. A Typical clinical appearance of an epidermoid inclusion cyst with a yellowish hue. Two pores are present in this example. B Painful inflammatory reactions to cyst rupture are a frequent cause for presentation to a physician. Culture will often prove these lesions to be sterile, even if draining pus. Antibiotic treatment can be helpful due to their anti-inflammatory effects. B, Courtesy, Mary S. Stone, MD.

• A soft cheese-like, sometimes malodorous, material composed primarily of keratin can usually be expressed from the opening.

• Cyst contents may rupture into the dermis, eliciting an acute and chronic inflammatory reaction, leading to significant redness and pain; this inflammation is often confused with a bacterial infection (Fig. 90.1B).

• Most commonly sporadic; multiple lesions rarely associated with Gardner syndrome or Gorlin syndrome.

• DDx: see Fig. 95.17.

• Rx: inflamed lesions: if fluctuant, can be incised and drained ± packed with gauze (a wick); if nonfluctuant, can be injected with intralesional CS; non-inflamed (‘cold’) lesions can be excised surgically but may result in a significant scar.

Milium (Milia – Plural)

• A small, superficial (1–2 mm), firm cyst that is white in color and is sometimes confused with a whitehead (Fig. 90.2); occasionally they are grouped.

Fig. 90.2 Milia. Tiny (1–2 mm), white, dome-shaped papules on the face.

• Occurs most frequently on the face, especially the periorbital region; seen in both children and adults.

• Commonly observed on the face in newborns; in this setting, they often resolve spontaneously.

• The majority of patients with multiple facial milia have no underlying condition; however, there may be a secondary cause (Table 90.1).

Table 90.1

Conditions associated with multiple milia.

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Apr 22, 2016 | Posted by admin in Dermatology | Comments Off

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