Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Digital Mucous Cyst Treatment & Management

  • Author: Murad Alam, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Mar 20, 2015
 

Medical Care

Medical care for digital mucous cysts (DMCs) includes the following:

  • Soaks
  • Local heat
  • Massage
  • Occlusive treatment with topical steroids and Cordran tape
  • Home remedies - Salves, poultices, and plasters
  • Application of heparin cream
  • Silver nitrate
  • Chemical cauterization with phenol
  • Digital compression, if the cyst is soft and located over a bony prominence
  • Striking with a large book (potential for unintended trauma)
  • X-ray therapy and radium irradiation (of historical interest only)
Next

Surgical Care

The most conservative surgical intervention entails multiple episodes of needling the cyst with a wide-bore needle until resolution is achieved. An appropriately trained patient may continue the repeated drainage and scarification required by this method at home.[9]

Another technique is cyst aspiration with a large-bore needle, followed by instillation of corticosteroids (triamcinolone, hydrocortisone, betamethasone) with or without lidocaine. Some practitioners prefer to inject proteolytic agents, such as hyaluronidase, in lieu of steroids, but this may be potentially more risky given the communication of the cyst with the joint.[10]

Cryosurgery has been used to treat digital mucous cysts. Carbon dioxide snow, cryoprobes, and the intermittent spray technique have been used.[11]

Sclerotherapy was considered a quick and effective method of treatment.[12] Among the sclerosants infused were Morton fluid, iodine and carbolic acid, sodium morrhuate, ethanolamine, sodium tetradecyl, and polidocanol. Some consider sclerotherapy a dangerous approach because of the potential for extravasation of the chemical into the joint or tendon sheath. However, a 2008 study reported effective treatment of digital mucous cysts with percutaneous sclerotherapy using polidocanol.[13]

Curettage of the cyst may be attempted, and this may or may not be combined with electrodesiccation. Caution should be exercised to reduce the risk of scar.

High-intensity light sources recently have demonstrated at least short-term success in the management of digital mucous cysts. Cysts have been vaporized with the carbon dioxide laser and treated with infrared contact coagulation.[14, 15]

Dermatologic and plastic surgeons have practiced cold-steel surgical excision of digital mucous cysts for several decades. This procedure ranges from simple excision of the cyst to wide, radical excision with possible graft[16] or flap reconstruction. Flaps used for reconstruction have historically been rotation flaps,[17] but rhomboid flaps[18] as well as advancement flaps[19] have been used safely and reliably and may be easier to apply in selected situations.

Another approach is marsupialization, or excision of the whole proximal nail fold, with subsequent healing by secondary intention.

In recent years, excision and debridement of joint osteophytes has been recognized as a necessary adjunct to reduce the risk of recurrence. Some hand surgeons believe that excision and debridement of the marginal osteophyte without removal of the cyst itself may be the best intervention. This results in less postoperative impairment in joint motion and fewer nail deformities since cyst dissection around the germinal matrix potentially may injure the underlying matrix and cause scarring. In general, more aggressive dissection leads to fewer recurrences and more nail deformities.

More recently, nail surgeons have attempted to treat recurrent or refractory cysts by repairing the causative leak of joint fluid in such lesions.[20] Methylene blue dye is first injected into the distal interphalangeal (DIP) joint. Then, a skin flap is raised around the cyst to find the area of dye-filled communication between the joint space and the cyst. This communication is then sutured shut and the flap is dropped back into place without tissue resection.

Overall, significant disagreement exists in the literature regarding optimal treatment approaches. Note the following:

  • Dermatologists tend to favor more conservative treatments such as multiple needling or aspiration followed by steroid injection; they have reported high success rates and relatively low risks of recurrence.
  • Hand surgeons have noted success and rare recurrence with osteophyte excision and debridement, but their patient population is comprised of those who fail other treatments. All of the literature is biased toward the minority of patients who seek medical care for their digital mucous cysts. Asymptomatic cysts and spontaneous regression appear to be common, with several series suggesting that the likelihood of the latter may approximate 50%.
  • Additionally, as the aggressiveness of interventions to treat digital mucous cysts increases, the associated costs also increase. Conservative treatments offer the prospect of low cost, low morbidity, and the elimination of disability and time loss related to recovery from surgery.
  • Consequently, a reasonable treatment plan for symptomatic digital mucous cysts may entail initial needling or aspiration and injection; if these modalities fail repeatedly, patients may be referred to a hand surgeon for more radical surgery but must be forewarned of the increased risk of complications and offered the option of simply deferring treatment for this essentially benign entity.
Previous
Next

Consultations

Consultation with a dermatologist, dermatologic surgeon, and/or hand surgeon may be warranted.

Previous
 
 
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
  1. Lin YC, Wu YH, Scher RK. Nail changes and association of osteoarthritis in digital myxoid cyst. Dermatol Surg. 2008 Mar. 34(3):364-9. [Medline].

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

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

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

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

  13. 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].

  14. 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].

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

  16. 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].

  17. 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].

  18. 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].

  19. 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].

  20. 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].

  21. Herndon JH, Myers SR, Akelman E. Advanced surgery. Scher RK, Daniel CR, eds. Nails: Therapy Diagnosis, Surgery. 2nd ed. Philadelphia: WB Saunders Co; 1997. 350-362.

  22. Norton LA. Tumors. Scher RK, Daniel CR, eds. Nails: Therapy, Diagnosis, Surgery. 2nd ed. Philadelphia: WB Saunders Co; 1997. 262-275.

 
Previous
Next
 
Digital mucous cyst proximal to nail unit.
Digital mucous cyst at proximal nail fold.
Histopathology of digital mucous cyst.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.