Steatocystoma Multiplex Clinical Presentation

  • Author: Mathew A Davey, MD; Chief Editor: William D James, MD   more...
 
Updated: Jan 12, 2012
 

History

Affected individuals often present with an increasing number of smooth flesh-to-yellow–colored cysts. The cysts are usually nontender and asymptomatic. On occasion, individual lesions may rupture into the dermis, become inflamed, and form sinus tracts with scarring. Secondary bacterial colonization can lead to malodorous discharge.

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Physical

Lesions present as numerous flesh-to-yellow–colored dermal cysts ranging in size from 3 mm to 3 cm. Individual cysts range from elastic to firm and are often freely movable. The lesions lack a central punctum. Cyst contents appear as an odorless creamy or oily fluid. Individual lesions of steatocystoma multiplex may become suppurative, increase in size, and become prone to rupture (termed steatocystoma multiplex suppurativum). In these cases, secondary bacterial colonization often leads to malodorous discharge. Significant scarring with sinus tract formation may occur.

In typical cases of steatocystoma multiplex, cysts are distributed in areas where high numbers of sebaceous glands are found, most commonly the chest, arms, axillae, and neck. Several reports of localized steatocystoma multiplex limited to the scalp, face, retroauricular region, groin, and nasal region have been reported.[8, 9] Acral steatocystoma multiplex, in which involvement of the extremities is more prominent than the trunk, is uncommon and was described by Rollins et al in 2000.[10]

Steatocystoma multiplex on the chest of an adolescSteatocystoma multiplex on the chest of an adolescent female. Steatocystoma multiplex with typical-appearing, smSteatocystoma multiplex with typical-appearing, smooth, yellow and white dermal cysts.

While some authors refer to localized steatocystoma multiplex as a specific condition, it shares pathological and clinical features of typical cases and is thought to represent a variant of the steatocystoma multiplex rather than a separate disease entity.[8] Linear variants have been reported,[6] and, although rare, generalized eruptions may occur.

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Causes

Steatocystoma multiplex is a disorder of the pilosebaceous unit that occurs in either a sporadic or an autosomal dominant fashion. Androgenic stimulation of the sebaceous gland, along with environmental factors and the site and type of the keratin mutation, influence the onset of the sebaceous cysts.[3]

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Contributor Information and Disclosures
Author

Mathew A Davey, MD  Resident Physician, Department of Dermatology, University of North Carolina at Chapel Hill

Mathew A Davey, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Craig N Burkhart, MD, MSBS  Assistant Professor, Department of Dermatology, University of North Carolina at Chapel Hill

Craig N Burkhart, MD, MSBS is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and American Medical Association

Disclosure: Nothing to disclose.

Dean Scott Morrell, MD  Associate Professor, Director of Residency Training Program, Director of Pediatric and Adolescent Dermatology, Department of Dermatology, University of North Carolina at Chapel Hill

Disclosure: Nothing to disclose.

Specialty Editor Board

Evan R Farmer, MD  Clinical Professor of Pathology and Dermatology, Department of Pathology, Virginia Commonwealth University School of Medicine

Evan R Farmer, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, and International Society of Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Warren R Heymann, MD  Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Mary Bane, MD, to the development and writing of this article.

References

  1. Jamieson WA. Case of numerous cutaneous cysts scattered over the body. Edin Med J. 1873;19:223-5.

  2. Cho S, Chang SE, Choi JH, Sung KJ, Moon KC, Koh JK. Clinical and histologic features of 64 cases of steatocystoma multiplex. J Dermatol. Mar 2002;29(3):152-6. [Medline].

  3. Oh SW, Kim MY, Lee JS, Kim SC. Keratin 17 mutation in pachyonychia congenita type 2 patient with early onset steatocystoma multiplex and Hutchinson-like tooth deformity. J Dermatol. Mar 2006;33(3):161-4. [Medline].

  4. Yamada A, Saga K, Jimbow K. Acquired multiple pilosebaceous cysts on the face having the histopathological features of steatocystoma multiplex and eruptive vellus hair cysts. Int J Dermatol. Oct 2005;44(10):861-3. [Medline].

  5. Tomková H, Fujimoto W, Arata J. Expression of keratins (K10 and K17) in steatocystoma multiplex, eruptive vellus hair cysts, and epidermoid and trichilemmal cysts. Am J Dermatopathol. Jun 1997;19(3):250-3. [Medline].

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  7. Riedel C, Brinkmeier T, Kutzne H, Plewig G, Frosch PJ. Late onset of a facial variant of steatocystoma multiplex - calretinin as a specific marker of the follicular companion cell layer. J Dtsch Dermatol Ges. Jun 2008;6(6):480-2. [Medline].

  8. Mortazavi H, Taheri A, Mansoori P, Kani ZA. Localized forms of steatocystoma multiplex: Case report and review of the literature. Dermatology Online Journal [serial online]. 2005;11:22. Available from: http://dermatology.cdlib.org/. Accessed October 21, 2008. Available at http://dermatology-s10.cdlib.org/111/case_presentations/steatocystoma/taheri.html.

  9. Lee D, Chun JS, Hong SK, Seo JK, Choi JH, Koh JK, et al. Steatocystoma multiplex confined to the scalp with concurrent alopecia. Ann Dermatol. Oct 2011;23:S258-60. [Medline]. [Full Text].

  10. Rollins T, Levin RM, Heymann WR. Acral steatocystoma multiplex. J Am Acad Dermatol. Aug 2000;43(2 Pt 2):396-9. [Medline].

  11. Duzova AN, Senturk GB. Suggestion for the treatment of steatocystoma multiplex located exclusively on the face. Int J Dermatol. Jan 2004;43(1):60-2. [Medline].

  12. Schmook T, Burg G, Hafner J. Surgical pearl: mini-incisions for the extraction of steatocystoma multiplex. J Am Acad Dermatol. Jun 2001;44(6):1041-2. [Medline].

  13. Kaya TI, Ikizoglu G, Kokturk A, Tursen U. A simple surgical technique for the treatment of steatocystoma multiplex. Int J Dermatol. Dec 2001;40(12):785-8. [Medline].

  14. Lee SJ, Choe YS, Park BC, Lee WJ, Kim do W. The vein hook successfully used for eradication of steatocystoma multiplex. Dermatologic Surgery. 2008;33:82-84.

  15. Choudhary S, Koley S, Salodkar A. A modified surgical technique for steatocystoma multiplex. J Cutan Aesthet Surg. Jan 2010;3(1):25-8. [Medline]. [Full Text].

  16. Rossi R, Cappugi P, Battini M, Mavilia L, Campolmi P. CO2 laser therapy in a case of steatocystoma multiplex with prominent nodules on the face and neck. Int J Dermatol. Apr 2003;42(4):302-4. [Medline].

  17. Adams BB, Mutasim DF, Nordlund JJ. Steatocystoma multiplex: a quick removal technique. Cutis. Aug 1999;64(2):127-30. [Medline].

  18. Brownstein MH. Steatocystoma simplex. A solitary steatocystoma. Arch Dermatol. Jun 1982;118(6):409-11. [Medline].

  19. Chu, D. H. Steatocystoma multiplex. Dermatology Online Journal [serial online]. 2003;9:18. Available from: http://dermatology.cdlib.org/. Accessed October 21, 2008. Available at http://dermatology.cdlib.org/94/NYU/Feb2002/7.html.

  20. Corden LD, McLean WH. Human keratin diseases: hereditary fragility of specific epithelial tissues. Exp Dermatol. Dec 1996;5(6):297-307. [Medline].

  21. Kaur T, Kanwar AJ. Steatocystoma multiplex in four successive generations. J Dermatol. Jul 2003;30(7):559-61. [Medline].

  22. Kligman AM, Kirschbaum JD. Steatocystoma multiplex: a dermoid tumor. J Invest Dermatol. May 1964;42:383-7. [Medline].

  23. Krahenbuhl A, Eichmann A, Pfaltz M. CO2 laser therapy for steatocystoma multiplex. Dermatologica. 1991;183(4):294-6. [Medline].

  24. Laquer VT, Wu JJ, Tournas JA, Murase JE, Dyson SW. Pruritic bluish-black subcutaneous papules on the chest. Dermatology Online Journal [serial online]. 2008;14:14. Available from: http://dermatology.cdlib.org/. Accessed October 21, 2008. Available at http://dermatology-s10.cdlib.org/143/case_presentations/steatocystoma/wu.html.

  25. Plewig G, Wolff HH, Braun-Falco O. Steatocystoma multiplex: anatomic reevaluation, electron microscopy, and autoradiography. Arch Dermatol Res. 1982;272(3-4):363-80. [Medline].

  26. Smith FJ, Corden LD, Rugg EL, et al. Missense mutations in keratin 17 cause either pachyonychia congenita type 2 or a phenotype resembling steatocystoma multiplex. J Invest Dermatol. Feb 1997;108(2):220-3. [Medline].

 
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Steatocystoma multiplex on the chest of an adolescent female.
Steatocystoma multiplex with typical-appearing, smooth, yellow and white dermal cysts.
Note the crenulated eosinophilic lining of the cyst wall (10X magnification).
Note the sebaceous glands within the cyst wall (2X scanning view).
 
 
 
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