Steatocystoma Multiplex Treatment & Management
- Author: Dean Scott Morrell, MD; Chief Editor: William D James, MD more...
Medical treatments have been used with variable results to lessen inflammation, minimize scarring, and reduce the need for surgery.
Treatment is indicated for this scarring inflammatory version of the disorder and involves antimicrobial therapy in combination with incision and drainage. The classic treatment is with the tetracycline class of antibiotics. Isotretinoin therapy has been effective in some patients; however, in others, it has caused the condition to flare. Recurrence following isotretinoin treatment has been reported.
The patient may require medical intervention for significantly deforming lesions when surgical approaches are impractical. Unfortunately, isotretinoin (despite its known effect of decreasing sebaceous gland activity) has shown inconsistent results. Flaring and recurrence following isotretinoin have been reported.
Cysts can be widespread and difficult to treat. A variety of surgical treatment options have been used in the treatment of steatocystoma multiplex.
Cryosurgery has been used in the past with limited success. Residual scarring limits this approach.
Simple aspiration with 18-gauge needle has been successful in minimizing scarring of facial lesions, although a high rate of recurrence has been observed. Variation of this method by insertion and gentle extirpation of cystic contents without removing the cyst wall has been shown to be successful, with no scarring and a low rate of recurrence. This technique is thought to be the treatment of choice in the management of facial lesions and those smaller than 1.5 cm in diameter. This approach may not be feasible with larger, more mature lesions with cyst contents of a more dense consistency.
Traditionally, surgical excision is the most commonly mentioned method of treatment. Excisional surgery with elliptical excisions, flaps, or grafts is oftentimes impractical for widespread lesions and has fallen out of favor secondary to its time-consuming nature and the associated risk of scarring. Punch excision followed by cyst removal has been used in the past, with mixed results.
Incisional variants of cyst removal have become the preferred methods of treatment. Mini-incisions of 1 mm with a No. 11 surgical blade followed by expression of cyst contents and excochleation of the cyst wall using a 1-mm curette resulted in minimal scarring and a low rate of recurrence. A modified surgical technique, used on more than 50 lesions, is sharp-tipped cautery followed by expression of cyst contents and forceps-assisted removal of the cyst wall. This technique resulted in minimal depressed scarring and slight hypopigmentation with no evidence of recurrence. Newer techniques with small incisions, 2-3 mm in length, followed by removal of the cyst wall with a phlebectomy hook resulted in satisfactory cosmesis, with no recurrence noted.[15, 16]
Carbon dioxide laser
Carbon dioxide laser ablation has allowed treatment of multiple lesions during a single treatment session, with no anesthesia, a low percentage of recurrence, and good aesthetic results.[17, 18, 19]
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