Treatment of Steatocystoma Multiplex Flare-Up
For acute inflammatory flare-ups of steatocystoma multiplex, the primary treatment is incision and drainage with extraction of the cyst wall using a modified surgical technique, which provides excellent cosmetic results and prevents recurrence.
Immediate Management of Inflamed Cysts
Surgical Intervention - First-Line Treatment
- The modified surgical technique is the treatment of choice for inflamed steatocystoma multiplex lesions 1, 2
- Puncture inflamed cysts under local anesthesia using a sharp-tipped cautery point or radiofrequency instrument 3, 1
- Evacuate cyst contents by gentle squeezing with fine forceps 1
- Extract the entire cyst wall through the small opening using forceps to prevent recurrence 3, 1
- This approach is well-tolerated, time-efficient, and produces excellent cosmetic outcomes with minimal scarring 3, 1
Advantages of This Technique
- Minimal blood loss compared to traditional excision 3
- Practically no post-inflammatory hyperpigmentation or hypopigmentation 3
- No recurrences observed in follow-up periods extending beyond 14 months 3, 1
- Can treat multiple lesions (>50 cysts) in a single session 1
Management of Severely Inflamed Cases
When Multiple Cysts Are Actively Inflamed
- Surgical incision, drainage, and electrocautery have proven beneficial for persistently infected, painful lesions 2
- Prioritize treating the most symptomatic and inflamed cysts first 2
- Stage procedures if the number of inflamed cysts is overwhelming, addressing the most problematic lesions initially 2
What NOT to Do
Avoid Isotretinoin During Flare-Ups
- Do not initiate or continue isotretinoin therapy during an active flare-up 4
- Isotretinoin can paradoxically cause rapid enlargement of pre-existing cysts and formation of new cysts in steatocystoma multiplex 4
- If a patient is already on isotretinoin when flare occurs, discontinue the medication 4
- While isotretinoin may improve inflamed cysts initially, it can subsequently exacerbate the condition after 8 weeks of therapy 4
Avoid Incomplete Procedures
- Simple aspiration without cyst wall removal leads to recurrence 3
- Traditional wide surgical excision is unnecessarily aggressive and produces inferior cosmetic results 1
- Cryosurgery alone is inadequate for treating inflamed lesions 3
Post-Procedure Management
- Monitor treated sites for signs of infection or recurrence 3, 1
- Follow-up at regular intervals to assess for new cyst formation 3, 1
- Counsel patients that this is an office-based procedure with minimal downtime 3