Atheroma is a cyst of the sebaceous gland, which is a cavity filled with a mushy secret. It has the appearance of a subcutaneously located, rounded, uplifting formation of a soft-elastic consistency. The atheroma easily shifts relative to the underlying tissues and slowly increases in volume, sometimes reaching 7-10 cm in diameter. The diagnosis is based on the data of general examination, ultrasound, histological examination. Surgical treatment involves the removal of the formation together with the capsule forming it, which eliminates the possibility of relapse. On the face, cysts can be removed by cystotomy to reduce the severity of postoperative scars.
D23 Other benign skin neoplasms
In the scientific literature, the pathological formation has a number of synonymous names: epidermoid or epidermal cyst, trichodermal cyst, epidermoid, steatocytoma, retention cyst. In everyday life, education is referred to as “fat”. Multiple neoplasms are called atheromatosis of the skin. Epidermoid cysts occur, according to various data, in 5-10% of the population, and in women twice as often as in men. The most typical age for the formation of atheromas is 20-30 years. However, as a rule, patients seek medical help after several years, when the formation reaches a significant size and becomes a noticeable cosmetic defect.
The main factor in the formation of retention cysts is the formation of an obstacle or significant difficulty in the outflow of sebaceous gland secretions against the background of ongoing sebum production. The causes of outflow disorders are diverse, often combined and mutually enhance each other’s effect. The main mechanisms of atheroma formation include:
- Features of the structure of the skin glands. Pathological changes in the structure of the sebaceous glands occur at the stage of embryonic development and are caused by genetic defects. The accumulation of secretions in the sebaceous glands that do not have an excretory duct begins in utero. In these cases, the first atheromas are diagnosed in the child immediately after birth.
- Changing the nature and quantity of the secret. An increase in the viscosity of sebum against the background of increased keratinization of the mouths of the ducts of the sebaceous glands leads to the formation of sebaceous plugs. This process is based on hormonal and psychogenic factors that contribute to the development of severe acne, fatty seborrhea, hyperhidrosis. These diseases are often the background on which atheromas develop.
- Mechanical damage to the skin. The process of scarring and epithelialization of the skin wound leads to narrowing or blockage of the duct of the sebaceous gland. Atheromas appear in places of healed cuts, combs and abrasions, permanent removal of unwanted hair. Often retention cysts begin to grow in place of opened and healed boils, drain ulcers.
- Adverse external influences. The probability of the appearance of atheromas is higher in persons who have been exposed to radioactive radiation, the action of ultraviolet radiation. The growth of sebaceous cysts can provoke frostbite and burns. This is supported by the fact that retention cysts often appear in open areas of the body, head and neck.
Secretions continue to be produced in the clogged sebaceous gland. The contents accumulate and begin to press on the walls of the cavity, gradually stretching them. An increase in the volume of the gland does not cause unpleasant sensations, itching or pain, since there is no compression of the nerve endings. The skin rises above the growing cyst, a rounded seal of a soft-elastic consistency is formed. Blood circulation in the area of the location of the atheroma does not change, since the volume of living tissues of the dermoid practically does not increase. The skin is above the formation of the usual color.
Gradually, a connective tissue capsule begins to form around the walls of the overgrown sebaceous gland. The inner surface of the cyst walls constantly produces a secret. Puncture and emptying of the cavity does not lead to recovery. The puncture site heals, and the cavity begins to fill with liquid fat secretions again. To avoid relapses, the peeling of the dermoid together with the capsule allows.
Atheromas are divided into groups according to histological structure and causes of occurrence. Differences in the cellular structure of cysts do not manifest themselves clinically in any way, therefore histological classification is of interest only to researchers. In practical dermatology, classification based on the peculiarities of the formation of atheromas is important. According to her , cysts from the sebaceous glands are divided into two groups:
- Congenital (primary or true). Their development is based on a genetic defect that affects the formation of sebaceous glands and their ducts. The development of cysts from skin bookmarks begins in utero, because congenital atheromas are often detected in newborns. They are rarely more than 0.5 cm in size . Usually there are multiple formations.
- Acquired (secondary or false). They develop in unchanged sebaceous glands when their lumen is blocked. They appear mainly in adult patients against the background of previous skin lesions, existing disorders of the activity of the sebaceous glands. They have been increasing in volume for a long time, reaching significant sizes. They are represented by single formations.
Retention cysts can develop on any part of the head, body and limbs where there are sebaceous glands, regardless of whether the ducts of the glands open to the surface of the skin or into the mouths of the hair follicles. In fact, this is any anatomical area, including the armpits and popliteal pits, with the exception of the palms and feet. False atheromas are more common on the head, neck, upper third of the back, face. The characteristic localization of true atheromas is the perineal region.
Externally, the cyst has the appearance of a rounded formation, slightly lifting the skin. The atheroma is soft to the touch, large cysts noticeably fluctuate during palpation due to the liquid contents. A blocked excretory duct may be visible on the surface of the cyst. The formation easily shifts along with the skin relative to the underlying tissues. The skin above the atheroma is not taken into the fold. The average size of an atheroma is 1-2 cm, but there are tumors up to 10 cm in diameter. The growth of the formation is not accompanied by unpleasant sensations, except in cases when the cyst is subjected to constant mechanical irritation when rubbing with clothes or combing.
There are single and multiple atheromas on the scalp. Trichodermal cysts reach sizes of 5 cm or more. On the skin covering them, the hair often thinns or falls out completely. Ulceration, bleeding, necrosis of surrounding tissues are characteristic. In patients suffering from oily seborrhea, atheromas located on the head, face and neck can become significantly thickened over time, the skin above them acquires a bluish hue, and when pressed, soreness is noted.
The most common complication of atheroma is its suppuration. The addition of infection leads to the development of an inflammatory reaction, a violation of the general condition, hyperthermia. This condition requires urgent medical attention.
Abscessing atheroma is also dangerous in cases when its contents are trying to squeeze out or restore the patency of the duct by mechanical means. Normally, the capsule surrounding the cyst helps to limit the purulent-inflammatory process. Mechanical action can destroy this barrier. The unhindered spread of pyogenic bacteria in the tissues leads to phlegmon, their entry into the bloodstream leads to sepsis.
The clinical picture of most benign neoplasms of the skin and subcutaneous tissue is largely similar. The dermatologist at the reception is faced with the task of conducting a differential diagnosis, determining the type of pathological formation, and choosing the most effective method of treatment. To do this , it is carried out:
- General inspection. During palpation, signs of a cavity formation with clear boundaries associated with the skin are determined. For diagnosis, the slow growth of a sebaceous cyst, the presence of a blocked gland opening on its surface is important. If there are signs of inflammation or mechanical irritation of the cyst, it is recommended to remove the formation in the near future.
- Ultrasound examination. It is carried out in complex diagnostic cases. Ultrasound of soft tissues allows you to visualize the capsule and the cavity filled with liquid contents. These data help to diagnose atheroma with 100% certainty. The study is informative for the differentiation of the epidermoid from lipoma (benign tumor from adipose tissue), fibroma (connective tissue node), hygroma (neoplasms from the sweat gland).
- Morphological diagnostics. Express diagnostics of the cellular composition of the neoplasm can be performed during surgery. It is also possible to conduct a histological examination after removal of the cyst in order to confirm the diagnosis and exclude the malignant nature of the tumor.
Approaches to the treatment of epidermal cysts in dermatology and outpatient surgery differ significantly. They are not mutually exclusive and can be effective in different clinical situations, because it is important not only to remove the neoplasm, but to choose treatment and care procedures in order to normalize the production of sebum, to prevent the appearance of new atheromas.
- Conservative treatment. It is prescribed at the stage of preparation for surgery, when it is necessary to stop inflammation. Ointments with anti-inflammatory and antibacterial components are used. In the postoperative period, in order to prevent the formation of new atheromas, medications and cosmetics for daily care that normalize the work of the sebaceous glands are selected for the patient.
- Cystectomy. A classic surgical operation for atheroma without signs of inflammation involves peeling the formation with a capsule through a small incision of the skin. Laser evaporation of the capsule, a radio-wave method of removing atheroma, also gives good results.
- Removal of a suppurated cyst. Abscessing atheroma is removed in two stages. At the first stage, an autopsy of the suppurated atheroma is performed: the contents of the cyst are evacuated through the incision, the cavity is washed with antiseptic solutions, local anti-inflammatory treatment is prescribed. At the second stage, after the inflammatory process subsides, the capsule is removed.
- Cystotomy. On the face, the preferred method of removing cysts is their puncture, emptying, creating conditions for tissue healing without suturing. After cystotomy, an atrophic scar of a rounded shape with a diameter of up to 4 mm remains in place of the formed hole, which is not regarded by patients as a cosmetic defect.
Prognosis and prevention
Timely referral to a dermatologist and cosmetologist about any changes in the condition of the skin and hair allows you to prevent the development of atheromas. Juvenile acne, seborrhea, increased oily skin are conditions that require correction and constant, properly selected supportive treatment. With already developed atheromatosis, it is indicated to conduct an examination of the hormonal background, correction of the detected disorders. It is advisable to abandon traumatic methods of hair removal (waxing, sugaring) in favor of laser hair removal, reduce the time spent in the sun and in the solarium.