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Sebaceous (epidermal) cysts develop as the result of blockage or damage to a hair follicle or sebaceous gland.
The patient notices an asymptomatic, dome-shaped, subcutaneous swelling, often with a central punctum. The cysts occur most commonly on the head and neck but also on the chest, back and genital areas. They may become infected, inflamed and discharge pus.
The cysts are harmless but may cause problems with shaving, combing the hair or, as in this patient, wearing spectacles. Removal is done under local anaesthetic. The cyst is opened and drained of its contents and its wall is removed. Antibiotics may be required if infection occurs.
In severe acne, cysts may form that are liable to become inflamed and subsequently leave permanent scars. Where there are large numbers of cysts, interconnecting abscesses and sinuses may form with an unsightly appearance. It is recommended that cases of cystic acne are referred early to a dermatologist so that isotretinoin can be considered. This can reduce the numbers of scars that will follow if it is left untreated.
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Milia in a baby
Milia are small epidermal cysts that develop from pilosebaceous follicles. They present as asymptomatic, firm, white or cream-coloured papules, 1-2mm in diameter. They may be single or multiple and occur on the face. They occur frequently in the newborn and in infancy, but usually disappear within a few weeks of birth.
Milia in an adult
Milia also occur commonly in adults, as in this elderly woman with a crop of milia on her forehead. They may occur spontaneously but may follow blistering disorders, dermabrasion or chronic sun damage. Treatment is unnecessary but, if the patient wishes, they can be treated by incision, pricking out or cautery.
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Sebaceous gland hyperplasia
Sebaceous gland hyperplasia in the newborn can alarm parents. A young baby may suddenly develop a crop of pinpoint yellow or white papules on the face, particularly over the nose and cheeks. Pilosebaceous glands in this area enlarge in response to maternal androgens. Alarming though it may seem, no treatment is necessary and the condition will normally resolve within a few weeks.
Syringoma are small tumours of the sweat ducts. They are more common in women and tend to appear first in the teenage years. They are most common in clusters around and on the eyelids, where they appear as small, smooth, skin-coloured or yellow papules. Syringoma may, at times be confused with xanthelasma. If necessary, the diagnosis can be confirmed by biopsy.
Treatment of these lesions is unnecessary but diathermy or laser treatment can be used if the patient is concerned about their appearance.
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Xanthomas occur as the result of the deposition of fat in the skin. Around the eyes the soft, flat, yellow plaques that result are known as xanthelasma.
Although these lesions may be associated with a hyperlipidaemia, xanthelasma may occur in patients with a normal lipid profile. However, it is sensible to check lipid levels so that the correct advice can be given if they are raised.
Some patients may be unhappy about their appearance and request treatment. Topical trichloroacetic acid, electrocautery, laser or excision are possible.
Dermal cylindroma is a relatively common tumour of the sweat gland that is more common in adult women. Usually it occurs as a single tumour on the head or neck. Occasionally, multiple lesions occur in patients with the autosomal dominant gene; in these cases, the tumours may cover the scalp, and it is then known as a turban tumour. The tumour appears as a nodule, more than 1cm in diameter, with a smooth surface, rubbery feel and surface telangiectasia. The lesions gradually increase in size. Occasionally a cylindroma will undergo malignant change with invasion of surrounding tissue.
Contributed by Dr Jean Watkins, a GP locum in Hampshire.