Steatocystoma Multiplex: Definition and Treatment
Steatocystoma multiplex is best treated with minimally invasive surgical techniques including CO2 laser perforation and extirpation or radiofrequency-assisted removal, which provide excellent cosmetic outcomes with minimal scarring and low recurrence rates. 1, 2, 3
Definition and Clinical Characteristics
Steatocystoma multiplex (SM) is a rare dermatological condition characterized by:
- Multiple sebum-containing dermal cysts
- Typically presents on the chest, arms, axilla, neck, and trunk
- Can be inherited in an autosomal dominant pattern or occur as a spontaneous mutation
- Cysts may occasionally exsanguinate oily material
- Benign condition but can have significant impact on quality of life due to cosmetic concerns 1, 4
Diagnostic Features
- Multiple circumscribed cysts visible on examination
- Histological confirmation may be required in uncertain cases
- May be confused with other cystic skin conditions
- Can be identified incidentally on imaging studies such as mammography 4
Treatment Options
First-line Treatment: Minimally Invasive Surgical Techniques
CO2 Laser Perforation and Extirpation:
- Uses carbon dioxide laser in super pulse mode to puncture the cyst
- Cyst wall and contents extirpated using a small Volkmann's spoon
- Results in minimal scarring and low recurrence rates
- High patient satisfaction reported 1
Modified Surgical Technique with Cautery:
- Puncturing cysts under local anesthesia with sharp-tipped cautery
- Evacuation of contents by squeezing with fine forceps
- Extraction of cyst wall through small holes
- Cosmetically excellent results with no recurrences in follow-up 2
Radiofrequency-Assisted Removal:
- Using radiofrequency instrument as the incision tool
- Simple, fast office-based procedure
- Minimal blood loss
- Virtually no post-inflammatory pigmentation changes or scarring 3
Alternative Approaches
- Traditional surgical excision (more invasive, greater scarring potential)
- Cryosurgery
- Aspiration (higher recurrence rates)
- Incision with surgical blade followed by expression of cyst contents 3
Treatment Selection Considerations
- Number and size of lesions: More numerous or larger lesions may require multiple treatment sessions
- Anatomical location: Treatment approach may vary based on cosmetically sensitive areas
- Patient preference: Considering cosmetic outcomes and recovery time
- Available expertise and equipment: CO2 laser or radiofrequency devices may not be available in all settings
Potential Complications and Management
- Scarring (minimal with recommended techniques)
- Recurrence (low rates with complete removal of cyst wall)
- Infection (rare with proper technique)
- Post-inflammatory pigmentation changes (minimal with recommended techniques)
Follow-up Recommendations
- Clinical assessment at 2-3 months post-procedure
- Monitoring for recurrence
- Additional treatment sessions may be required for new lesions or recurrences
The minimally invasive surgical techniques described above represent the current best approach to treating steatocystoma multiplex, balancing effective removal of cysts with excellent cosmetic outcomes and patient satisfaction.