Multiple Epidermal Cysts Following Resolution of Hidradenitis Suppurative on the Legs in a Patient with Crohn’s Disease

Multiple epidermal cysts over the scrotum is a rare condition and requires excision if infected or cosmetically unacceptable. Grossly enlarged or infected cysts require total excision of the scrotal wall followed by the coverage of bare testes. We are reporting a case of multiple epidermal cysts on the scrotum. Total excision of scrotal wall followed by the fascio cutaneous flap coverage was done in this case.

A case of non-involuting congenital haemangioma with multiple epidermal cysts

Dear Editor: A 58-year-old woman presented with multiple tiny papules having comedo-like openings on her face (Fig. 1A). Three years previously, she had received gold acupuncture with permanent needles for facial skin rejuvenation that was performed by an unlicensed acupuncturist. After the procedure, the acupuncture treatment site was swollen for 3 months. At the same site, multiple papules with a pungent odor appeared. Punch biopsies were performed for the lesions in the infraorbital and forehead areas to confirm the diagnosis of multiple epidermal cysts associated with gold acupuncture, and gold needles were detected from the lesions (Fig. 1B). Histopathological analysis revealed a cyst lined with stratified squamous epithelium containing a granular layer, and a cavity that was filled with laminated keratinous material (Fig. 2). Therefore, the diagnosis of multiple epidermal cysts associated with gold acupuncture was confirmed. The patient was treated with intralesional triamcinolone injections and 2% salicylic acid for the multiple epidermal cysts, which resulted in mild improvement of the lesions. A few larger epidermal cysts were removed via simple excision. However, most of the foul-smelling lesions remained, and the patient discontinued follow-up for personal reasons. Fig. 1 (A) Facial lesions that developed 3 years after a gold acupuncture procedure. Multiple erythematous-based papules and nodules can be observed in the periorbital area. Numerous skin-colored papules and nodules with comedo-like openings having a foul odor ... Fig. 2 Histopathological analysis of the right infraorbital lesion revealed a cyst lined with stratified squamous epithelium containing a granular layer, and a cavity that was filled with laminated keratinous material (H&E, ×100). Acupuncture has recently attracted enormous interest in Asian countries, and has gained some degree of acceptance in Western medicine1. To potentiate the effects of simple acupuncture treatment, various stimulation methods such as electroacupuncture, ultrasound acupuncture, laser acupuncture, aqua-acupuncture, and implantation at acupoints have been developed over the last half of the century by combining new medical techniques2. Traditional Chinese acupuncture involves placing needles into the subcutaneous tissues along predefined meridians and then removing all the needles later. However, a unique type of acupuncture known as 'Hari' involves permanent placement of fine needles into the subcutaneous tissues3. These needles are made of gold, silver, or stainless steel, and may be placed anywhere in the body4. Acupuncture is also used for facial rejuvenation. Barrett5 reported that facial rejuvenation is achieved by inserting acupuncture needles at different points. However, the mechanism of acupuncture for rejuvenation is not clear and its safety has not yet been proven. The adverse effects of acupuncture treatment include bleeding, hematoma, sweating, fainting, fever, and skin irritation1. However, there has been no description of an epidermal cyst caused by gold acupuncture involving the permanent placement of needles. Epidermal cysts are the most common cutaneous cysts, and are derived from the follicular infundibulum. Epidermal cysts may be primary, or they may arise from disrupted follicular structures or traumatically implanted epithelium. They have been reported to develop after trauma, radiotherapy, and surgical procedures such as needle biopsy and lumbar puncture involving the use of needles with a stylet. To our knowledge, this is the first case of multiple epidermal cysts after permanent implantation of gold needles. Insertion of gold needles might cause disruption of the epithelium, leading to the occurrence of these cysts. Implanted gold needles could also induce epidermal cysts by injuring the follicular epithelium or blocking the follicular opening. We assume that despite their rare occurrence, epidermal cysts are a possible complication of this procedure. Only well-trained practitioners should perform acupuncture, and efforts should be made to minimize the risks related to this procedure. Informed consent for patient's photographs was obtained.

Multiple epidermal inclusion cysts in a patient with rheumatoid arthritis: a case report.

Development of Multiple Epidermal Inclusion Cysts After Radiofrequency Microtenotomy for Plantar Fasciitis: A Case Report

Multiple epidermal cysts over the scrotum is a rare condition and requires surgical intervention if infected or cosmetically unacceptable. Grossly enlarged cysts require complete excision, followed by scrotoplasty. We are reporting a case of multiple epidermal cysts on the scrotum. Complete excision of the cysts followed by scrotoplasty was done in this case.

Gardner syndrome, a phenotypic variant of familial adenomatous polyposis, is characterized by the classical clinical triad of skin and soft tissue tumours, osteomas and intestinal polyposis, but disease patterns with pairs of these findings have also been reported. Different mutations in the adenomatous polyposis coli (APC) gene have been shown to be associated with Gardner syndrome disease phenotypes. A 36-year-old patient presented with multiple epidermal cysts on the face, left ear lobe and neck, and the possible diagnosis of Gardner syndrome was based on the additional findings of two classical osteomas in the left radius and ulna and a cold non-malignant nodule of the thyroid gland. Intestinal polyposis was lacking at the time of examination. Major deletions but not microdeletions were excluded by a cytogenetic analysis with 650 chromosomal bands per haploid set. Systematic sequencing of the entire coding region of the APC gene (> 8500 bp) of the patient and five healthy controls was also performed. As a results, new APC gene polymorphisms were identified in exons 13 [A545A (A/G)] and 15 [G1678G (A/G), S1756S (G/T), P1960P (A/G)]. We also detected D1822V (A/T) which has recently been reported to be potentially related to colorectal carcinoma, and genotyped 194 randomly chosen healthy individuals from the Glasgow area for this as well as for the above variants in exons 13 and 15. Interestingly, of the 194 controls, 112 carried the DD (57.7%), 71 the DV (36.6%), and the remaining 11 (5.7%), including our patient, the VV genotype. It is therefore unlikely that APC D1822V serves as an important marker for colorectal carcinoma. In conclusion, we failed to identify obvious germline candidate mutations in > 8500 bp of the coding region of the APC gene in a patient with multiple epidermal cysts, osteomas and a thyroid gland nodule; major chromosomal deletions were excluded. Therefore, we assume that only the presence of intestinal polyposis is a marker for Gardner syndrome.

Epidermal cysts most commonly occur in hair-bearing areas, such as the scalp, face, neck, trunk, and scrotum, where many pilosebaceous glands are present [1,2]. Epidermal cysts do not commonly develop in the palmoplantar skin due to the absence of pilosebaceous glands. The etiology of epidermal cysts on the palms and soles may not involve inflammation of the hair follicle, but the traumatic implantation of epidermal elements [1,3]. In this report, we describe a case of multiple epidermal cysts that developed in the volar skin of the thumb. A 53-year-old man visited our outpatient plastic surgery clinic, presenting with a slow-growing protruding mass on the left thumb (Fig. 1). He was a carpenter by occupation, and the mass developed after recurrent mechanical trauma by hammering for several decades. The 2.5×2-cm mass was located on the volar side of the distal phalanx of the left thumb. Upon physical examination, the mass was movable, without tenderness, redness, or a sense of warmth. We performed a simple X-ray of the hand to evaluate potential bony abnormalities and ultrasonography to determine the characteristics of the mass. The simple X-ray showed a normal bony appearance without bony erosion due to mass effect. We also found three subcutaneous low echoic masses on ultrasonography (Fig. 2). The overlying skin was incised horizontally and four masses were resected (Fig. 3). Mild adhesion was noted between the masses and the surrounding tissue, which was completely resected. The light microscopic examination of hematoxylin-eosin-stained sections was performed for all masses, which were diagnosed as epidermal cysts by a pathologist (Fig. 4). The wound was closed directly and followed up for two weeks. No complications, such as dehiscence, necrosis, hematoma, tingling sensation or hypoesthesia, or motility dysfunction occurred. Fig. 1 A 2.5×2-cm protruding subcutaneous mass on the left thumb without an abnormal skin lesion. Fig. 2 Three lobulated heterogeneous hypoechoic masses were seen on ultrasonography. The size of the largest mass was 1.3×0.6×1.2 cm and the other two small masses measured 0.5×0.5 cm each. Fig. 3 During the operation, a total of four masses were removed without any remnants. Fig. 4 A postoperative biopsy showed keratin material (KM) surrounded by stratified squamous epithelium (SE) and a granular cell layer adjacent to the keratin-containing cyst lumen. The result was compatible with an epidermal cyst. H&E stain. (A) ×40. ... Epidermal cysts usually result from inflammation around pilosebaceous follicles [4]. However, no pilosebaceous follicles are present in the skin of the palm and the sole of the foot. Epidermal cysts in the palmoplantar skin have been assumed to result from the implantation of epidermal fragments due to a penetrating injury or another form of epidermal trauma [1,5]. Recently, some palmoplantar epidermal cysts have been reported to be caused by human papilloma virus (HPV) infection [4,5]. The pathophysiology of the epidermal cyst in this patient was presumed to be the implantation of an epidermal fragment, since the patient in this case had a history of recurrent occupational mechanical trauma [1,3]. We did not test for HPV infection because the patient did not present any symptoms or signs thereof. Epidermal cysts in the palmoplantar skin are easily confused with warts or calluses. Surgeons should be aware of the possibility of epidermal cysts in palmoplantar skin and be able to diagnose them correctly and design an appropriate treatment strategy.

Epidermal inclusion cyst is one of the common benign soft tissue tumors, and it can be easily confirmed and treated by surgical excision. We experienced a patient who had multiple masses on the face and scalp region, and the masses had been misdiagnosed as neurofibromatosis because of accompanying mental retardation. We would like to introduce a case of clinical diagnosis error caused by the lack of radiologic evaluation and pathologic confirmation. A 27-year-old male patient visited with multiple masses, with a length of approximately 1 to 10 cm on the face and scalp region. These mass have developed since childhood without known etiology, and there has been no histologic examination or surgical excision done in the past. The patient's history of seizure disorder and mental retardation led the primary clinician to diagnose it as neurofibromatosis in the initial stage, and therefore, the clinician gave an advice on the possibility of frequent recurrence to the patient. As the masses increased in size, the patient came to our hospital after all. We found that the masses were soft and mobile through the physical examination, and magnetic resonance imaging showed evidence of epidermal inclusion cyst, which is distinguished from neurofibromatosis. Based on physical examination and magnetic resonance imaging, we performed total excision and biopsies. On the histologic examination, it was diagnosed as an epidermal inclusion cyst showing keratotic material internally, and the cyst wall was composed of lamellate keratin. The follow-up period was 12 months, and a recurrence has not occurred. The wound was healed without any specific complication, and both the patient and the guardian were satisfied with the physical enhancement. We have observed a misdiagnosed case that was misconceived by the situation, accompanying mental retardation. Due to this misconception, any surgical treatment was not performed at all, and the symptoms eventually worsened as multiple huge epidermal inclusion cysts. We present this case with a brief review of literature.

Fibroadenomas in postmenopausal women are quite uncommon, and so are epidermal inclusion cysts in the breast. The coexistence of both is very rare, and very limited literature is available about this occurrence. We report a postmenopausal female patient with complaints of breast lump masquerading as malignancy on triple assessment which upon subsequent histopathological evaluation was confirmed to be fibroadenoma with intervening multiple epidermal inclusion cysts. In addition, the epidermal inclusions cysts were seen within the fibroadenoma without any association with the overlying skin and adnexa, adding to its rarity. So far, this is probably the fourth such case report to be documented in the literature with such coexistence and the first of its kind to be reported in a postmenopausal woman.

International Journal of DermatologyVolume 47, Issue 11 p. 1197-1198 Multiple epidermal inclusion cysts after axillary liposuction-curettage: a rare complication of a frequent procedure F. G. Bechara MD, F. G. Bechara MD Department of Dermatology and Allergology, Ruhr-University, Bochum, GermanySearch for more papers by this authorM. Sand MD, M. Sand MD Department of General and Visceral Surgery, Augusta Kranken Anstalt, Academic Teaching Hospital of the Ruhr-University, Bochum, GermanySearch for more papers by this authorS. Rotterdam MD, S. Rotterdam MD Department of Dermatology and Allergology, Ruhr-University, Bochum, GermanySearch for more papers by this authorP. Altmeyer MD, P. Altmeyer MD Department of Dermatology and Allergology, Ruhr-University, Bochum, GermanySearch for more papers by this authorK. Hoffmann MD, K. Hoffmann MD Department of Dermatology and Allergology, Ruhr-University, Bochum, GermanySearch for more papers by this author F. G. Bechara MD, F. G. Bechara MD Department of Dermatology and Allergology, Ruhr-University, Bochum, GermanySearch for more papers by this authorM. Sand MD, M. Sand MD Department of General and Visceral Surgery, Augusta Kranken Anstalt, Academic Teaching Hospital of the Ruhr-University, Bochum, GermanySearch for more papers by this authorS. Rotterdam MD, S. Rotterdam MD Department of Dermatology and Allergology, Ruhr-University, Bochum, GermanySearch for more papers by this authorP. Altmeyer MD, P. Altmeyer MD Department of Dermatology and Allergology, Ruhr-University, Bochum, GermanySearch for more papers by this authorK. Hoffmann MD, K. Hoffmann MD Department of Dermatology and Allergology, Ruhr-University, Bochum, GermanySearch for more papers by this author First published: 29 October 2008 https://doi.org/10.1111/j.1365-4632.2008.03686.xCitations: 2 Falk Georges Bechara, MD Department of Dermatology and Allergology Ruhr-University Bochum St. Josef Hospital Gudrunstr. 56 44791 Bochum GermanyE-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume47, Issue11November 2008Pages 1197-1198 RelatedInformation

Excision of multiple epidermal facial cysts in Gardner's syndrome

ejd.2011.1626 Auteur(s) : Kazutoshi Murao kmurao@clin.med.tokushima-u.ac.jp, Yoshiaki Kubo Department of Dermatology, Institute of Health Biosciences, 3-15-18 Kuramoto-cho, Tokushima City 770-8503, Japan There are many cutaneous manifestations in hemodialysis patients, such as pruritus, xerosis, cutaneous pigmentation, or perforating dermatosis [1]. However, multiple cyst formation is not a common skin manifestation in hemodialysis patients. Here we report two cases of multiple epidermal cysts developing [...]

The epidermal cyst is one of the most common cysts occurring in the labia. It is believed to develop from the inclusion of squamous epithelium in the dermis during embryological reorganisation or from misplaced squamous epithelium due to trauma. It presents as an asymptomatic, stationary or gradually enlarging, round, firm subcutaneous swelling a few millimeters to a few centimeters in size. Multiple epidermal cysts may sometimes be associated with Gardner’s syndrome (osteoma, gastrointestinal polyposis usually of malignant variety; Knox and Freeman 1965). Post-circumcisional epidermal cysts of the clitoris are reported to be common complications in some parts of Nigeria (Ofadile et al. 1979).

The Journal of DermatologyVolume 44, Issue 1 p. 105-107 Letter to the Editor Multiple protrusive epidermal cysts on the scalp of a Lowe syndrome patient Susumu Ikehara, Susumu Ikehara Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JapanSearch for more papers by this authorAtsushi Utani, Corresponding Author Atsushi Utani utani@nagasaki-u.ac.jp Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JapanCorrespondence: Atsushi Utani, M.D., Ph.D., Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Email: utani@nagasaki-u.ac.jpSearch for more papers by this author Susumu Ikehara, Susumu Ikehara Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JapanSearch for more papers by this authorAtsushi Utani, Corresponding Author Atsushi Utani utani@nagasaki-u.ac.jp Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JapanCorrespondence: Atsushi Utani, M.D., Ph.D., Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Email: utani@nagasaki-u.ac.jpSearch for more papers by this author First published: 14 May 2016 https://doi.org/10.1111/1346-8138.13444Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume44, Issue1January 2017Pages 105-107 RelatedInformation