Effect of Epidermoid Cysts on the Efficacy of Intralesional Corticosteroid Therapy for Hypertrophic Scars and Keloids: A Prospective Pilot Study

BACKGROUND

Patients with hypertrophic scars (HSs) or keloids occasionally have epidermoid cysts (ECs), and the effect of ECs on the effectiveness of intralesional corticosteroids (ILCs) treatment in these patients has not been reported.

OBJECTIVE

This study aims to evaluate the influence of ECs on the outcomes of ILCs treatment in patients with HSs or keloids.

MATERIALS AND METHODS

This prospective study included 572 patients with keloids ( n = 461) or HSs ( n = 111). Patients received intralesional triamcinolone acetonide injection (0.05 mL/injection) at a concentration of 40 mg/mL and every 28 days for 4 sessions, with a 1-year follow-up.

RESULTS

A higher incidence of ECs was observed in keloid patients (16.92%) compared with HSs patients (7.21%). Keloid patients with ECs were older ( p = .008) and had a longer disease duration ( p = .0148), higher Vancouver scar scale (VSS) scores ( p = .04), and greater thickness ( p = .006). Keloid patients with ECs showed less improvement in VSS scores ( p < .0001) and thickness ( p < .0001) after ILCs treatment, with a higher recurrence rate ( p < .0001). The overall complication rate in keloid patients with ECs after ILCs treatment was 49.51%.

CONCLUSION

Epidermoid cysts under keloids were associated with a poor response to ILCs therapy. Therefore, it is recommended to incorporate ultrasonography as a routine examination for keloid patients to aid in better decision making in clinical practice.

One-stage excision of inflamed sebaceous cyst versus the conventional method

OBJECTIVE

The aim of this trial was to determine whether one-stage excision of inflamed sebaceous cysts is preferable to the conventional method.

METHODS

A group of 166 patients underwent primary resection of an inflamed sebaceous cyst followed by 5 days' administration of antibiotics. A further 185 patients underwent conventional treatment consisting of initial antibiotic administration and incision and drainage of the lesion, followed by elective surgical excision 1-2 months later when the inflammation had subsided. Duration of antibiotic exposure, morbidity and cost were compared between the two groups.

RESULTS

One-stage excision of inflamed sebaceous cysts decreased the duration of antibiotic exposure, reduced morbidity and is more economical.

CONCLUSION

This study strongly suggests that, provided cases are appropriately selected, primary resection of inflamed sebaceous cysts has advantages over conventional treatment.

Milia after allergic contact dermatitis from poison ivy: two cases

Milia have rarely been reported as a complication of severe allergic contact dermatitis. To our knowledge, milia have not previously been associated with poison ivy dermatitis. We present two cases of milia after allergic contact dermatitis to poison ivy.

Eruptive vellus hair cysts: report of a pediatric case with partial response to calcipotriene therapy

Eruptive vellus hair cysts (EVHCs) are characterized by asymptomatic, follicular, comedonelike papules usually located on the anterior chest and abdomen. We present a pediatric case of EVHC associated with attention deficit hyperactivity disorder that partially responded to calcipotriene cream within 2 months. Our aim is to refamiliarize clinicians with a common albeit frequently unrecognized disorder of vellus hair follicles.

Survey of antibiotic prescription use for inflamed epidermal inclusion cysts

BACKGROUND

Symptomatic epidermal inclusion cysts (EICs) are variously called "inflamed" or "infected," and the mechanism of inflammation or suppuration is controversial. Whether physicians routinely prescribe antibiotics for inflamed EICs is of concern owing to cost and bacterial resistance.

OBJECTIVES

To determine whether there is any difference in the diagnosis and treatment of EICs between primary care physicians and dermatologists and to estimate the rate and cost of antibiotic prescriptions for EICs.

METHODS

One hundred twenty-five primary care physicians and 52 dermatologists were surveyed using a standard case study and a photograph.

RESULTS

Sixty-seven percent of the primary care physicians used the term "infected," whereas 69% of the dermatologists used the term "inflamed" or "ruptured." Eighty-four percent of the general practitioners and 94% of the dermatologists chose antibiotics for treatment.

CONCLUSION

This study shows that despite the differences between general practitioners and dermatologists in diagnosis, the majority of physicians use antibiotics for the treatment of inflamed EICs.

Migraine, Botulinum Toxin type-A, and the Disappearing Sebaceous Cyst

Botulinum toxin type-A has been used with increasing frequency as a migraine prophylactic agent. A recent case of ours had an unexpected beneficial effect on a local comorbid condition.

Intralesional administration of formalin for treatment of epidermal inclusion cysts in five horses

Five horses with unilateral epidermal inclusion cysts located in the nasal diverticula were sedated and treated with intralesional injection of neutral-buffered 10% formalin (volume range, 2 to 4.5 mL). After aspiration of the cyst, formalin was injected intralesionally until leakage of fluid around the needle was observed. After several weeks, desiccation of the cyst was evident; it was excised 2 weeks after treatment in 3 horses, digitally removed by the owner of 1 horse, and never removed in 1 horse, because the owner declined further treatment after resolution of the original swelling of the nasal diverticulum. Swelling of the cyst after treatment was observed in all horses; nasal discharge (2 horses) and a mild episode of epistaxis (1 horse) were the only other complications of the treatment. Intralesional administration of formalin appears to be a simple and effective treatment for epidermal inclusion cysts in the nasal diverticula of horses.

Intracranial epidermoid cyst in a horse

An intracranial epidermoid cyst was diagnosed in a Haflinger gelding aged 12 years suffering from episodes of neurological disturbance, apathy and fever. The extracerebral cyst was located in the region of the tentorium cerebelli and measured 9 x 8 x 5 cm. It displaced the cerebral hemispheres anteriorly and compressed the cerebellum and brainstem underneath. Histologically, the cyst was lined by keratinizing, stratified squamous epithelium and contained keratin scales, debris, focal haemorrhages, and degenerating inflammatory cells. The epithelium was supported by a vascularized fibrous capsule that firmly adhered to the dura mater. Multifocal haemorrhages and moderate lymphohistiocytic infiltrations were present in the capsule. The basement membrane was disrupted focally, and single or clustered cytokeratin-positive epithelial cells were detected in the fibrous capsule, suggesting a possible transition to malignancy.

Spinal epidermoid tumors: novel approach to aseptic meningitis

Intraoperative hydrocortisone irrigation of the cerebrospinal fluid pathways may reduce symptoms attributed to aseptic meningitis, which often follow the resection of epidermoid spinal tumors. Here, 20 patients undergoing surgical resection of epidermoid tumors were randomly assigned to two groups: Group I received intraoperative hydrocortisone irrigation, whereas Group II served as a control. No patient receiving hydrocortisone experienced fevers or meningismus, but nontreated patients experienced fevers (100%) and meningismus (78%). Nausea and vomiting were reduced (9%) in the treated versus untreated groups (22% vs. 11%, respectively), whereas none in the treated group noted dizziness, vertigo, or diabetes insipidus. As steroid irrigation significantly decreased the perioperative morbidity of epidermoid tumor resection, indications for intravenous steroids may become more limited, thereby reducing cost.

Treatment of epidermal cysts with Solcoderm (a copper ion and acid solution)

The treatment of epidermal cysts has often posed a problem for dermatologists. Although surgical excision has been adopted as the method of choice for the removal of these lesions, complications of surgery and recurrences have warranted the search for alternate therapeutic modalities. Use of a recently introduced compound, Solcoderm, is reported in the treatment of 116 epidermal cysts in 85 patients over a 2-year period. The satisfactory cosmetic results observed, low incidence of recurrence, low cost and ease of administration, make this drug a viable alternative in the management of epidermal cysts, particularly in those cases where surgery should be avoided.

Eruptive vellus hair cysts and neurologic abnormalities: two related conditions?

A fifteen-year-old white boy with a history of seizure disorder, borderline cognitive function, academic difficulty, and explosive temper outbursts was evaluated for asymptomatic flesh-colored papules appearing on his chest, abdomen, and axillae. Examination of a biopsy specimen showed eruptive vellus hair cysts; results of genetic, endocrinologic, and neuropsychiatric evaluation revealed abnormalities suggestive of a previously undescribed neurocutaneous syndrome.

Steatocystoma multiplex treated with isotretinoin: a delayed response

A patient with steatocystoma multiplex was treated with 0.75 mg per kg per day of oral isotretinoin. After one month of minimal improvement the patient discontinued therapy. Over the next two months he noted some shrinkage of his pre-existing lesions, which persisted for a follow-up period of six months. Isotretinoin may show a beneficial response in some cases of steatocystoma multiplex even after use of the drug is discontinued. Isotretinoin is known to have effects beyond its treatment period that are related to its long serum half-life. A small number of patients with steatocystoma multiplex have been treated with isotretinoin, with varied responses. This is the first case of a patient who discontinued therapy before a response occurred and then showed a response later.

Familial occurrence of eruptive vellus hair cysts

A 15-year-old white male had an extensive skin eruption that had been present since age 2 years. Physical examination revealed flesh-colored, rough-textured papules surrounded by faint erythema. These lesions were present diffusely over the upper trunk, arms, thighs, face, ears, and neck. Evaluation of four immediate family members revealed a similarly affected brother and father. A biopsy of the papules showed the presence of a mid-dermal epithelial cyst containing numerous vellus hairs.

Treatment of steatocystoma multiplex and pseudofolliculitis barbae with isotretinoin

A 20-year old man with steatocystoma multiplex and pseudofolliculitis barbae was treated unsuccessfully with oral isotretinoin. Consistent with findings from previous reports, treatment with isotretinoin should be reserved for patients with steatocystoma multiplex suppurativum.

Steatocystoma multiplex suppurativum: treatment with isotretinoin

A patient with steatocystoma multiplex with multiple ruptured draining cysts and abscesses was treated with a twenty-week course of isotretinoin. Abscesses involuted and inflamed cysts shrank. The remission persisted for ten weeks after discontinuing therapy; subsequently cysts and abscesses occurred in multiple sites.

[Treatment of acne with orally administered isotretinoin. Clinical study of 56 patients]

56 patients with nodulocystic acne, hidrosadenitis (2 cases) and steatocystoma multiplex (2 cases) were treated with oral isotretinoin. 52 patients cleared completely or were much improved without local treatment; 2 failures involved patients with steatocystoma, while 2 patients with ano-inguinal lesions were only improved. 19 patients received a dose of 0.5 mg/kg/day for six months; in 37 patients the dose was adapted to the initial response but did not exceed 1 mg/kg/day. Reversible elevated triglyceride concentration was observed in 5% of the patients. 18 patients were followed up and 4 (22%) presented moderate relapses.

[Cortison-instillation -- treatment of an orbital epidermis cyst (author's transl)]

An orbital epidermiscyst about 23 mm diameter was treated and cured with instillation of triamcinolone.