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.^[15]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.

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.^[16]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.^[17]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.^[18]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.^{[19, 20]}

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.^{[21, 22, 23, 24]}

Use of nonablative fractional diode laser has also been reported with favorable and durable results.^[25]

Medication

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Media Gallery

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).

of 4

Author

Carolyn M Ziemer, MD, MPH Assistant Professor of Dermatology, Director of Dermatology Inpatient Consult Service, Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine

Carolyn M Ziemer, MD, MPH is a member of the following medical societies: American Academy of Dermatology, Medical Dermatology Society, North Carolina Dermatology Association, Society of Dermatology Hospitalists, Women's Dermatologic Society

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: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

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, MSBS is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

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.

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.