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Steatocystoma Multiplex Treatment & Management

  • Author: Dean Scott Morrell, MD; Chief Editor: William D James, MD  more...
 
Updated: Jun 06, 2016
 

Medical Care

Medical treatments have been used with variable results to lessen inflammation, minimize scarring, and reduce the need for surgery.

Steatocystoma suppurativa

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.

Disfiguring lesions

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.

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Surgical Care

Cysts can be widespread and difficult to treat. A variety of surgical treatment options have been used in the treatment of steatocystoma multiplex.

Cryosurgery

Cryosurgery has been used in the past with limited success. Residual scarring limits this approach.

Aspiration

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.[12] This approach may not be feasible with larger, more mature lesions with cyst contents of a more dense consistency.

Surgical excision

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

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.[13] 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.[14] 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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Contributor Information and Disclosures
Author

Dean Scott Morrell, MD Professor, Director of Dermatology 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

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steven R Feldman, MD, PhD Professor, Departments of Dermatology, Pathology and Public Health Sciences, and Molecular Medicine and Translational Science, Wake Forest Baptist Health; Director, Center for Dermatology Research, Director of Industry Relations, Department of Dermatology, Wake Forest University School of Medicine

Steven R Feldman, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, North Carolina Medical Society, Society for Investigative Dermatology

Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbvie for consulting; Received honoraria from Galderma for speaking and teaching; Received consulting fee from Lilly for consulting; Received ownership interest from www.DrScore.com for management position; Received ownership interest from Causa Reseasrch for management position; Received grant/research funds from Janssen for consulting; Received honoraria from Pfizer for speaking and teaching; Received consulting fee from No.

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, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

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

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

Disclosure: Nothing to disclose.

Mathew A Davey, MD, FAAD Dermatologist, Advanced Dermatology of the Midlands

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

Disclosure: Nothing to disclose.

Arash Taheri, MD Research Fellow, Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference 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. 2002 Mar. 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. 2006 Mar. 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. 2005 Oct. 44(10):861-3. [Medline].

  5. Papakonstantinou E, Franke I, Gollnick H. Facial steatocystoma multiplex combined with eruptive vellus hair cysts: a hybrid?. J Eur Acad Dermatol Venereol. 2014 Jul 30. [Medline].

  6. 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. 1997 Jun. 19(3):250-3. [Medline].

  7. Park YM, Cho SH, Kang H. Congenital linear steatocystoma multiplex of the nose. Pediatr Dermatol. 2000 Mar-Apr. 17(2):136-8. [Medline].

  8. 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. 2008 Jun. 6(6):480-2. [Medline].

  9. Mortazavi H, Taheri A, Mansoori P, Kani ZA. Localized forms of steatocystoma multiplex: Case report and review of the literature. Dermatology Online Journal. 2005. 11:22. [Full Text].

  10. 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. 2011 Oct. 23:S258-60. [Medline]. [Full Text].

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

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

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

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

  15. 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.

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

  17. 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. 2003 Apr. 42(4):302-4. [Medline].

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

  19. Bakkour W, Madan V. Carbon dioxide laser perforation and extirpation of steatocystoma multiplex. Dermatol Surg. 2014 Jun. 40(6):658-62. [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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