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Digital Mucous Cyst Clinical Presentation

  • Author: Murad Alam, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Aug 12, 2016
 

History

Typically, the cysts are asymptomatic. They may appear suddenly or develop over a period of months. Grooving of the nail may precede the clinical manifestation of the cyst itself by up to 6 months. Often, osteoarthritis of the small joints is noted at the site of cyst emergence. Intermittent spontaneous discharge of cyst contents can occur, and, in a significant fraction of cases, cysts may disappear spontaneously.

Antecedent trauma has been documented in a small minority of cases. As cysts enlarge, pain is an increasingly common complaint. Patients are also likely to complain about the appearance of larger cysts and may report interference with function.

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Physical

Pertinent physical findings are limited to the skin, joints, and nail unit. Note the images below.

Digital mucous cyst proximal to nail unit. Digital mucous cyst proximal to nail unit.
Digital mucous cyst at proximal nail fold. Digital mucous cyst at proximal nail fold.

Digital mucous cysts are usually solitary, round-to-oval, dome-shaped, firm-to-fluctuant papulonodules from 1-10 mm in diameter that have overlying skin that ranges from very thin to moderately thick. The cysts contain a viscous, gelatinous fluid that may be clear or yellow-tinged. Some cysts are verrucose. Pain is associated with relatively larger cysts.

The cysts are located off the midline of the digits and, according to one series, are more common on the radial than ulnar aspect of the fingers. They most often are found on the dorsolateral aspect of the fingers, intradermally, between the DIP joint and proximal nail fold.[2] Less frequently, they occur between the proximal nail fold and the nail plate, beneath the nail matrix, or in the pulp of the digit. Cysts most frequently are found on the middle or index finger of the dominant hand; toe involvement is less common.[3] Cysts located under the nail plate (subungual cysts) have common features that have been characterized in one series. In most cases, the lunula is discolored (most often red, less often blue) and transverse curvature of the nail is almost always increased, frequently resulting in lateral ingrowth

Digital mucous cysts are translucent to flesh-colored. One case report described a herpetiform appearance.[4] Lesions may be solitary or present as multiple nodules.[5] When they are under the nail matrix, a red lunula and a longitudinal brownish band may be seen.

Longitudinal grooving or depression of the nail occurs when digital mucous cysts involve the posterior nail fold. Grooving may be accompanied by transverse ridging and thinning of the nail overlying the cyst. Gross disruption of the nail is less common. Digital mucous cysts are more likely to be above than below the nail matrix.

A consensus has emerged that digital mucous cysts are frequently, if not always, located at osteoarthritic joints.

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Causes

The causes of digital mucous cysts remain unclear. Historically, a variety of etiologies, including a tuberculous process, have been suggested. At present, it is believed that mucoid degeneration of connective tissue associated with proximal osteoarthritic changes is responsible for cyst formation. Trauma also may be a causative factor in some cases.

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Contributor Information and Disclosures
Author

Murad Alam, MD Professor of Dermatology, Otolaryngology, and Surgery; Chief, Section of Cutaneous and Aesthetic Surgery, Department of Dermatology, Northwestern University; Director, Mohs Micrographic Surgery, Northwestern Memorial Hospital

Murad Alam, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Medical Association, American Society of Transplantation, Phi Beta Kappa, Society for Investigative Dermatology, American College of Aesthetic and Cosmetic Physicians; American Society of Aesthetic/Cosmetic Physicians, Women's Dermatologic Society, Dermatology Foundation, Illinois Dermatological Society, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Natalie Ann Kim-Orden, MD Intern, Children's Hospital of Los Angeles

Disclosure: Nothing to disclose.

Melanie Warycha, MD Procedural Dermatology Fellow, Department of Dermatology, Northwestern University Feinberg School of Medicine

Melanie Warycha, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, Women's Dermatologic Society, Medical Dermatology Society

Disclosure: Nothing to disclose.

Kira Minkis, MD, PhD Director of Mohs and Dermatologic Surgery, Director of Surgical, Laser, and Cosmetic Education, Assistant Professor, Department of Dermatology, Weill Cornell Medical College; Attending Physician, New York Presbyterian Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Richard K Scher, MD Adjunct Professor of Dermatology, University of North Carolina at Chapel Hill School of Medicine; Professor Emeritus of Dermatology, Columbia University College of Physicians and Surgeons

Richard K Scher, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American Medical Association, Association of Military Surgeons of the US, International Society for Dermatologic Surgery, Noah Worcester Dermatological Society, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

David Bickers, MD, Chairman, Carl Truman Nelson Professor, Department of Dermatology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons

Disclosure: Nothing to disclose.

Mary Farley, MD Dermatologic Surgeon/Mohs Surgeon, Anne Arundel Surgery Center

Disclosure: Nothing to disclose.

References
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  2. Salerni G, Alonso C. Images in clinical medicine. Digital mucous cyst. N Engl J Med. 2012 Apr 5. 366(14):1335. [Medline].

  3. Kivanc-Altunay I, Kumbasar E, Gokdemir G, Koslu A, Tekkesin M, Basak T. Unusual localization of multiple myxoid (mucous) cysts of toes. Dermatol Online J. 2004 Jul 15. 10(1):23. [Medline].

  4. Hur J, Kim YS, Yeo KY, Kim JS, Yu HJ. A case of herpetiform appearance of digital mucous cysts. Ann Dermatol. 2010 May. 22(2):194-5. [Medline]. [Full Text].

  5. Hwang CY, Huang YL, Liu HN. Digital mucous cysts presenting as numerous translucent nodules in the right fifth finger. J Chin Med Assoc. 2011 Feb. 74(2):102-3. [Medline].

  6. Drape JL, Idy-Peretti I, Goettmann S, et al. MR imaging of digital mucoid cysts. Radiology. 1996 Aug. 200(2):531-6. [Medline].

  7. Daffner RH, Whitfield PW. Recurrent ganglion cyst: the value of preoperative ganglionography. AJR Am J Roentgenol. 1977 Aug. 129(2):345-6. [Medline].

  8. Dodd LG, Layfield LJ. Fine-needle aspiration cytology of ganglion cysts. Diagn Cytopathol. 1996 Dec. 15(5):377-81. [Medline].

  9. Esson GA, Holme SA. Treatment of 63 Subjects With Digital Mucous Cysts With Percutaneous Sclerotherapy Using Polidocanol. Dermatol Surg. 2016 Jan. 42 (1):59-62. [Medline].

  10. Epstein E. A simple technique for managing digital mucous cysts. Arch Dermatol. 1979 Nov. 115(11):1315-6. [Medline].

  11. Epstein E. Steroid injection of myxoid finger cysts. JAMA. 1965. 194:98-99.

  12. Bardach HG. Managing digital mucoid cysts by cryosurgery with liquid nitrogen: preliminary report. J Dermatol Surg Oncol. 1983 Jun. 9(6):455-8. [Medline].

  13. Audebert C. Treatment of mucoid cysts of fingers and toes by injection of sclerosant. Dermatol Clin. 1989 Jan. 7(1):179-81. [Medline].

  14. Córdoba S, Romero A, Hernández-Nuñez A, Borbujo JM. Treatment of digital mucous cysts with percutaneous sclerotherapy using polidocanol. Dermatol Surg. 2008 Oct. 34(10):1387-8; discussion 1388. [Medline].

  15. Huerter CJ, Wheeland RG, Bailin PL, Ratz JL. Treatment of digital myxoid cysts with carbon dioxide laser vaporization. J Dermatol Surg Oncol. 1987 Jul. 13(7):723-7. [Medline].

  16. Kemmett D, Colver GB. Myxoid cysts treated by infra-red coagulation. Clin Exp Dermatol. 1994 Mar. 19(2):118-20. [Medline].

  17. Jamnadas-Khoda B, Agarwal R, Harper R, Page RE. Use of Wolfe Graft for the Treatment of Mucous Cysts. J Hand Surg Eur Vol. 2009 Apr 24. [Medline].

  18. Blume PA, Moore JC, Novicki DC. Digital mucoid cyst excision by using the bilobed flap technique and arthroplastic resection. J Foot Ankle Surg. 2005 Jan-Feb. 44(1):44-8. [Medline].

  19. Imran D, Koukkou C, Bainbridge LC. The rhomboid flap: a simple technique to cover the skin defect produced by excision of a mucous cyst of a digit. J Bone Joint Surg Br. 2003 Aug. 85(6):860-2. [Medline].

  20. Johnson SM, Treon K, Thomas S, Cox QG. A reliable surgical treatment for digital mucous cysts. J Hand Surg Eur Vol. 2013 Oct 25. [Medline].

  21. de Berker D, Lawrence C. Ganglion of the distal interphalangeal joint (myxoid cyst): therapy by identification and repair of the leak of joint fluid. Arch Dermatol. 2001 May. 137(5):607-10. [Medline].

 
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Digital mucous cyst proximal to nail unit.
Digital mucous cyst at proximal nail fold.
Histopathology of digital mucous cyst.
 
 
 
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