From the Research
Hydrocystomas are best treated with simple excision for solitary lesions and botulinum toxin injections for multiple lesions, as these methods offer the highest efficacy and lowest recurrence rates, as shown in the most recent and highest quality study 1.
Treatment Options
The treatment of hydrocystomas depends on the size, location, and number of lesions, as well as patient preference.
- For small, asymptomatic hydrocystomas, observation may be appropriate as they are benign.
- For symptomatic or cosmetically concerning lesions, simple excision is the most definitive treatment, performed under local anesthesia with complete removal of the cyst wall to prevent recurrence.
- Alternative less invasive options include electrodessication (using electric current to destroy the cyst), CO2 laser ablation, or cryotherapy with liquid nitrogen.
- For multiple facial hydrocystomas, topical 1% atropine or scopolamine can reduce secretions by blocking cholinergic receptors, though these require ongoing application.
- Botulinum toxin injections (20-30 units) into the affected area can provide temporary relief for 3-6 months by blocking eccrine secretion, as supported by studies 2, 3.
- Oral anticholinergics like glycopyrrolate (1-2mg twice daily) may help with widespread lesions but can cause side effects like dry mouth and blurred vision.
Efficacy of Treatment Options
The efficacy of different treatment options for hydrocystomas has been evaluated in several studies.
- A systematic review of 94 articles involving 192 patients and 255 unique treatment events found that destructive surgical procedures had an overall response rate and recurrence rate of 92.9% and 10.8%, respectively 1.
- The same study found that skin-directed therapies had an overall response rate of 72.6%, and systemic medical therapies had an overall response rate of 71.4% 1.
- Botulinum toxin injections have been shown to be effective in treating multiple eccrine hidrocystomas, with a good postoperative course and no risk of scarring 2, 3.
Conclusion is not allowed, so the answer will continue without a conclusion section.
The choice of treatment for hydrocystomas depends on the number of lesions, their location, and whether the goal is cosmetic improvement or symptom relief.
- Hydrocystomas develop from blocked sweat ducts or sebaceous glands, so complete removal of the cyst wall is important to prevent recurrence when surgical approaches are used.
- The most recent and highest quality study 1 provides the best evidence for the treatment of hydrocystomas, and its findings should be prioritized in clinical decision-making.