Usefulness of Dermoscopy in the Differential Diagnosis of Ruptured and Unruptured Epidermal Cysts

Abstract

BackgroundAn epidermal cyst is a common keratin-filled epithelial-lined cyst. The treatment of choice for epidermal cysts is surgical excision. If the cyst becomes ruptured, incision and drainage with oral antibiotic therapy or intralesional steroid injection are required.ObjectiveTo analyze the dermoscopic features that can differentiate between ruptured and unruptured epidermal cysts.MethodsThe clinical and dermoscopic features of the pathologically confirmed epidermal cysts of two subgroups of 38 patients, 20 with unruptured cysts and 18 with ruptured cysts, were reviewed.ResultsWith regard to the dermoscopic features, an ivory- white background color and punctum were commonly found in both groups (p>0.05). The unruptured-cyst group showed higher frequencies of pore sign (p<0.05), blue-white veil (p>0.05), no vascular structure, and arborizing telangiectasia (p<0.05), but the ruptured-cyst group usually had red lacunae (p>0.05) and peripheral linear branched vessels (with an erythematous rim) (p<0.05).ConclusionDermoscopy is helpful in differentiating between ruptured and unruptured epidermal cysts.

Sonographic appearance of sebaceous cysts. Our experience and a review of the literature

“…Given the limitations of retrospective series evaluation, our study has confirmed the importance of using high frequency probes in evaluating skin lesions also for sebaceous cysts, for better characterization and, consequently, better differential diagnosis, which is fundamental in patients with multiple and concurrent dermatological diseases in everyday clinical practice . In our experience with higher frequency probes and in more significant case series, the morphostructural characteristics described in the literature for the diagnosis of so‐called sebaceous cysts were confirmed, but moreover it showed the high incidence and diagnostic significance of so‐called skin pores, which is a usual finding of these lesions and therefore extremely significant for the differential diagnosis of this disease …”

“…Depending on their location, we often use probes with different frequencies for the same lesion in order to gain an optimal visualization of both deep and the more superficial structures. In particular, high frequency probes for sebaceous cysts provide the ability to better characterize the more superficial structures, such as skin pores, which are outpouchings that extend from the cyst to the epidermis, an expression of an obstructed piliferous follicle from which the disease originates, thus making up its peculiar characteristic . In fact, from our experience, cysts in 97 out of 118 cases are almost always visible.…”

“…In particular, high frequency probes for sebaceous cysts provide the ability to better characterize the more superficial structures, such as skin pores, which are outpouchings that extend from the cyst to the epidermis, an expression of an obstructed piliferous follicle from which the disease originates, thus making up its peculiar characteristic. 2,13,14 In fact, from our experience, cysts in 97 out of 118 cases are almost However, almost all of these studies are based on numerically modest cases (from a maximum of 61 lesions to a minimum of 17 lesions), using medium-high frequency probes (maximum 15 MHz) and none at very high frequencies, higher than 15 MHz. All of these studies describe sebaceous cysts as superficial lesions with a prevalent oval-shaped morphology and regular margins.…”

“…From a clinical perspective, one of the characteristics of epidermoid cysts is the visibility of a superficial dark spot, which represents the obstructed piliferous follicle caused by the disease. However, these data are not always easily visible, which is why some authors have proposed to adopt a dermoscopy as a diagnostic method . Often, the difficulties of clinical diagnosis, as well as the need to exclude in the differential diagnosis in different clinical diseases, leads dermatologists to prescribe ultrasound examinations.…”

“…However, these data are not always easily visible, which is why some authors have proposed to adopt a dermoscopy as a diagnostic method. 2,13 Often, the difficulties of clinical diagnosis, as well as the need to exclude in the differential diagnosis in different clinical diseases, leads dermatologists to prescribe ultrasound examinations. This diagnostic method, in the hands of an expert operator and with appropriate high-frequency probes, is currently the basic gold standard in the noninvasive study of these diseases.…”