Steatocystoma multiplex

Published on 18/03/2015 by admin

Filed under Dermatology

Last modified 22/04/2025

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Steatocystoma multiplex

Roy A. Palmer, Ian Coulson and Martin Keefe

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

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Although probably genetically heterogeneous, steatocystoma multiplex often demonstrates an autosomal dominant pattern of inheritance. Some pedigrees have demonstrable keratin 17 abnormalities. It is characterized by the development in adolescence or early adulthood of cysts on the trunk and proximal limbs, or in some patients on the face and scalp. These are true ‘sebaceous cysts’: they contain sebum, and sebaceous gland lobules are present in the walls. Overlap with eruptive vellus cysts and association with pachyonychia congenita type II have been reported.

Management strategy

The cysts persist indefinitely. Although usually a minor cosmetic problem, they can be highly disfiguring. Paradoxically, those patients who would benefit the most from treatment are sometimes regarded as being unsuitable for surgery because they have too many cysts to excise. The surgical technique described below is quick, and so can be used on large numbers of lesions in one session. It produces good cosmetic results.

Lesions can become inflamed due to rupture of the cyst wall with leakage of the contents into the dermis, or because of bacterial infection. Suppuration and scarring may follow. The clinical picture then resembles cystic acne and is called steatocystoma multiplex suppurativum. Oral isotretinoin is an effective treatment for inflammatory lesions but not for non-inflamed cysts. This suggests it operates by a direct anti-inflammatory effect rather than by reducing the sebum excretion rate. Alternatively, inflamed cysts can be treated with incision and drainage, intralesional triamcinolone, tetracycline 1 g/day, or minocycline 100–200 mg/day.

Topical treatment is largely ineffective because it does not penetrate to reach the cyst wall.

First-line therapies

Inflamed lesions  
image Isotretinon D
image Antibiotics E
image Incision and drainage E
Lesions not inflamed  
image Surgical incision and extraction of cyst wall D

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