Treatment of Steatocystoma Multiplex
The optimal treatment for steatocystoma multiplex is surgical extraction of the cyst wall through small puncture sites using cautery or sharp instruments, which provides excellent cosmetic results and prevents recurrence.
Primary Treatment Approach
Surgical extraction with complete cyst wall removal is the definitive treatment for steatocystoma multiplex, as incomplete removal leads to recurrence 1. The modified surgical technique involves:
- Puncturing cysts with a sharp-tipped cautery point under local anesthesia 1
- Evacuating cyst contents by squeezing with fine forceps 1
- Grasping and extracting the entire cyst wall through the small puncture hole 1
- This technique successfully treated over 50 cysts in a single patient with no recurrences at 14-month follow-up and excellent cosmetic outcomes 1
Alternative Diagnostic and Therapeutic Options
Fine Needle Aspiration
For patients with numerous lesions where complete surgical treatment is impractical:
- Fine needle aspiration (22-gauge needle) can both diagnose and treat small lesions (4-5mm) 2
- This approach is inexpensive, well-tolerated, and has no associated morbidity 2
- However, aspiration alone without cyst wall removal may lead to recurrence 2
Medical Management for Inflammatory Variants
When steatocystoma multiplex suppurativa (SMS) coexists with hidradenitis suppurativa:
- Adalimumab at standard dosing (160mg day 1, 80mg day 15, then 40mg weekly) effectively treats both inflammatory and non-inflammatory cystic lesions 3
- This represents an important option when inflammatory features are present, as SMS can share overlapping features with hidradenitis suppurativa 3
Important Clinical Considerations
Complete excision of the cyst wall is critical - simple drainage or aspiration without wall removal will result in recurrence 1. The modified surgical technique offers several advantages:
- Time-efficient for treating multiple lesions in one session 1
- Superior cosmetic outcomes compared to traditional surgical excision 1
- Minimal complications and excellent patient tolerance 1
Common Pitfall to Avoid
Do not perform traditional wide surgical excision for multiple lesions, as this creates unnecessary scarring and morbidity when the modified puncture technique achieves superior results 1.