Let’s talk about Steatocystoma multiplex

Let’s talk about a condition called Steatocystoma multiplex.
A condition that affects the pilosebaceous units with formation of sebum containing dermal cysts. Once you hear pilosebaceous in dermatology, it refers to something related to the hair follicle and sebaceous glands. The sebaceous glands open into the hair follicle so there can be disorders connecting the two of them. Can you guess another chronic disorder affecting the pilosebaceous unit? You’re correct if you mentioned acne!

So back to steatocystoma multiplex..It may be inherited as an autosomal dominant condition or may occur sporadically. Incidence is equal in both gender and tends to occur around puberty/adolescence. Usually affects the trunk mostly but can affect the arms, face, head less commonly. Mostly doesn’t give any symptoms except for the unsightly look. However some might become inflamed and irritated. Usually contains some cheesy looking material that smells a little funny. Almost like what comes out when you express acne lesions.

Management usually varies. Depends on the no of lesions and what patient wants. You can leave alone especially if the patient isn’t bothered. Some antibiotics like tetracyclines may help. Drugs like the retinoids have also been used. Surgery may be done especially if its single (in which case it is called steatocystoma uniplex.. dermatology is not hard really…lol). There’s a process called extirpation where you puncture each one with a needle and get the contents out. Usually a bit painful for both the doctor and patient…lol (Imagine doing that on each lesion especially if its much). Then CO2 LASER which is an ablative LASER will also do the work.

Let’s talk about the differentials. You all mentioned good ones. Let’s help differentiate between steatocystoma and your differentials..
Remember that steatocystoma forms dermal cysts like I said before. And the dermis is the deeper layer of the skin. So any lesion that is dermal looks like its arising from underneath and not on the surface. Can you appreciate that with the picture I showed? Except for the inflamed ones (the red ones), you can see most look like they’re arising from under.

Molluscum contagiosum on the other hand is an epidermal lesion (top layer of the skin), although there’s invagination into the dermis. I have a picture of molluscum here and you can see that they’re on “top” of the skin and not underneath. Then they usually have a central umbilication with the pearly color. It is caused by a virus called Pox virus. Molluscum contagiosum. Can you see how it appears stuck on? With the umbilication?

Nodulocystic acne as the name implies is a variant of acne that presents with nodules and cysts of varying sizes. A lot of them may be inflamed and the face is the most commonly involved site. Didn’t put a picture of this as I know we’ve all seen one before.

Other differentials include Eruptive vellus hair cysts, syringomas, epidermal inclusion cysts amongst others. By the time you’re getting to this stage…please refer to us promptly…lol

Thank you all for trying. Very good differentials. And to those that got it right…I’m recruiting more dermatologists please.

Any comments, questions or clarifications?

Picture of steatocystoma from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371868/ and that of Molluscum from Accessmedicine. All accessed via Google images