A Retrospective Chart Review of Inflamed Epidermal Inclusion Cysts.

BACKGROUND: Epidermal inclusion cysts (EIC) are one of the most common forms of cysts found on and/or underneath the skin. Inflamed EICs typically show signs and symptoms such as pain and erythema, mimicking cutaneous abscess. However, prior studies have demonstrated at least 20% of lesions are culture negative. OBJECTIVE: To determine the rate of culture positivity in mild inflamed epidermal inclusion cysts, in particular to identify whether empiric antibiotics are warranted. METHODS: In a retrospective chart review 76 cases of inflamed EIC that were mild (lacking systemic symptoms) were analyzed who presented to the department of dermatology at Mount Sinai between 2016–2019. RESULTS: Of cultures taken from inflamed cysts, 47% resulted in no bacterial growth or growth of normal flora, 38.4% resulted in growth of aerobic bacteria with methicillin-resistant Staphylococcus aureus (8%), Staphylococcus lugdunensis (5%), and methicillin-sensitive Staphylococcus aureus (13%) predominating, and 9.3% resulting in growth of anaerobic bacteria with Finegoldia magna, Peptostreptococcus, and Cutibacterium acnes presenting. Review of prescribed treatment regimens often involved antibiotic medication, despite a high prevalence of negative culture. CONCLUSIONS: Almost half of cases of mild inflamed EIC (lacking systemic symptoms) cultured will not grow pathogenic bacteria, therefore incision and drainage with culture and appropriate therapy is a viable therapeutic option in uncomplicated inflamed EIC lesions. In this way, over prescription of antibiotics can be minimized. J Drugs Dermatol. 2021;20(2):199-202. doi:10.36849/JDD.5014.

[Unusually infected sebaceous cyst by Dermabacter hominis]. / Un caso inusual de quiste sebáceo infectado por Dermabacter hominis.

Dermabacter hominis species is constituted by Gram positive facultative anaerobic coryneform rods being part of the resident microbiota human skin, and exceptionally associated to infections in immunocompromised or severely debilitated patients. An immunocompetent young adult woman with a neck sebaceous cyst infected by D. hominis as unique etiologic agent is presented. Phenotypic identification of the causative agent was achieved through simple tests, based on the originally scheme proposed by Funke and Bernard, and feasible to be performed in a hospital Microbiology Laboratory. Phenotypic characteristics as coccoid morphology, the acrid/spermatic odor, esculin hydrolysis, the production of pyrrolidonyl-arylamidase, lysine and ornithine decarboxylase, are key tests to identify D. hominis. The matrix-asisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) confirmed the phenotypic identification.

Efficacy of the combination of minimally invasive CO2 laser incision with photodynamic therapy for infected epidermoid cysts.

BACKGROUND: There are three main techniques for the removal of epidermoid cysts: traditional wide excision, minimal excision, and punch biopsy excision. For inflamed cysts, the wall is more friable and, therefore, more difficult to remove completely. The classic surgical excision always leads to a long scar or high rate of recurrence. CO2 laser has been proven to result in minimal incision, less bleeding, no suture, and a smaller or no scar. Photodynamic therapy (PDT) has been proposed as an antimicrobial alternative for common and drug-resistant bacteria in nonspecific and multiple sites. It was also shown to be effective in accelerating healing and inhibiting excessive proliferation of hyperplastic scar. Thus, we combined minimally invasive CO2 laser incision with PDT for epidermoid cysts with infection. METHODS: Thirty-three patients had a total of 39 infectious cysts. Two of the patients withdrew due to the high cost after 1 treatment session. After local injection of anesthesia, a hole measuring 2-3 mm was made at the pore in the upper part of the cyst along skin texture by CO2 laser (power 5 W, surgical pattern). The contents of the cyst were extracted through the hole using a curette and compression with gauze. PDT was then performed immediately. A total of 3 PDT sessions were recommended. The overall clinical effects, recurrence rates, cosmetic outcomes, adverse events, and patient satisfaction were assessed. RESULTS: We achieved a 97% success rate in 31 patients with 34 lesions using a combination of minimally invasive CO2 laser incision with PDT. At the 6- to 12-month follow-up, 30 of the patients had excellent cosmetic outcomes and satisfactory therapeutic effect. Pain during the illumination process, which can be relieved by dynamic cold air, was the primary adverse event. CONCLUSION: Our results demonstrate promise for the combination of minimally invasive CO2 laser incision with PDT as a safe and effective therapy for epidermoid cysts with infection. This treatment can inactivate a wide range of microbes including gram-positive and -negative bacteria, without developing drug resistance. Furthermore, it can promote fast wound healing and reduce scar formation.

Angiosarcoma of the scalp mimicking a sebaceous cyst.

A 58-year-old Caucasian woman presented with a cystic lump behind the right ear that was clinically diagnosed as an infected sebaceous cyst. The lesion was treated with incision and drainage followed by antibiotics for 3 months. Because there was no resolution, a biopsy was performed that revealed a high grade angiosarcoma. She expired 2 months later. Cutaneous angiosarcoma is an extremely aggressive tumor. Therefore early diagnosis and management is crucial in providing better patient care.

Management of Infected Sebaceous Cyst by Suture Closure: A New Approach.

Incision and drainage is the management plan of any infected sebaceous cyst from old age. But in infected sebaceous cyst, we can treat it in a simple way.Under local or general anesthesia the infected tissue is excised along with a rim of healthy tissue and then closed by Prolene in the same sitting. Usually stitches are removed on 21st day in the back and 14th day in the limb. This cross sectional observational study was carried out in the Department of Surgery of 250 Bed District Hospital, Kishoreganj and local clinics of Kishoreganj, Bangladesh from January 2012 to March 2015. One hundred (100) cases were selected with clinical diagnosis of infected sebaceous cyst and the procedure was carefully explained to every patients. The overall results were analyzed and it was revealed that with this method patients got quick recovery and no need for frequent dressing which prevents cross infection. It is cost effective and saves time also.

Actinomyces israelii may produce vulvar lesions suspicious for malignancy.

BACKGROUND: We present a case of Actinomyces israelii causing vulvar mass suspicious for malignancy in a postmenopausal woman. CASE: A 60 year-old woman presented due to a firm, nonmobile, 10 cm vulvar mass, which had been rapidly enlarging for 5 months. The mass was painful, with localized pruritus and sinus tracts oozing of serosanguinous fluid. Biopsy and cultures revealed a ruptured epidermal inclusion cyst containing granulation tissue and Actinomyces israelii. CONCLUSION: Actinomyces israelii may produce vulvar lesions that are suspicious for malignancy. Thus, biopsies and cultures are both mandatory while evaluating vulvar masses suspicious for malignancy.

Microbiology of infected epidermal cysts.

Specimens from 231 epidermal cyst abscesses were inoculated on media supportive for growth of aerobic and anaerobic bacteria. Of these, 192 yielded bacterial growth. Aerobic or facultative bacteria only were recovered in 84 specimens (44%), anaerobic bacteria only in 57 specimens (30%), and mixed aerobic and anaerobic bacteria in 51 specimens (26%). A total of 315 isolates (162 anaerobes and 153 aerobes) were recovered. An average of 0.8 aerobic or facultative isolates per infected cyst were recovered, and this number was unrelated to the cysts' anatomic sites. However, the number of anaerobic bacteria varied; they were isolated more frequently in perirectal (1.5 isolates per specimen), vulvovaginal (1.4), and head (1.1) infections, and less frequently in trunk (0.7) and extremities (0.4) infections. The predominant aerobic or facultative bacteria were Staphylococcus aureus (81 isolates), group A streptococcus (9 isolates), and Escherichia coli (7 isolates). The predominant anaerobic organisms were Peptostreptococcus species (85 isolates) and Bacteroides species (55 isolates, including 12 Bacteroides melaninogenicus and 9 Bacteroides fragilis groups). The study highlights the polymicrobial nature and predominance of anaerobes in cyst abscesses in the perirectal, vulvovaginal, and head areas.

Verrucous cyst.

Human papillomavirus has been detected in a variety of cutaneous premalignant and malignant conditions, as well as in benign cutaneous warts. Changes consistent with epidermis papilloma virus infection occurring in epidermal cysts have recently been reported in the dermatologic literature only in plantar epidermal cysts. We report five examples of a form of cutaneous cyst that is histologically distinctive and that has not been previously reported, to our knowledge. We describe five cases of epidermal cysts showing marked verrucous changes of their stratified squamous inner linings, some of which also show proliferative changes. Human papillomavirus genomes were detected via polymerase chain reaction. None of the DNA probes for Southern blot hybridization demonstrated homology with the human papillomavirus types usually associated with cutaneous warts or carcinoma. We believe this cyst to represent a newly described manifestation of human papillomavirus infection, and propose the name verrucous cyst for this entity. Further studies may reveal the specific human papillomavirus type(s) associated with the verrucous cyst.

'Cystic papilloma' in humans? Demonstration of human papillomavirus in plantar epidermoid cysts.

Fourteen cases of plantar epidermoid cyst were studied immunohistochemically and five of them were also studied electron microscopically for the presence of human papillomavirus. In eleven cases, the test results were positive for papillomavirus antigens, and in five of them, papillomaviruslike particles were observed by electron microscopy. Histological examination showed most of the cysts to contain intracytoplasmic eosinophilic bodies in cells of the cyst wall as well as the vacuolar structures in the keratinous mass within the cavity. These findings suggest an etiologic association between the papillomavirus and plantar epidermoid cysts. The "cystic papilloma" produced in rabbits by the Shope papillomavirus has been clearly demonstrated. We propose that human papillomaviruses play an important role in the genesis of plantar epidermoid cysts. This is the first report on the possible existence of a cystic papilloma in humans.

Analysis of the proinflammatory property of epidermal cyst contents: chemotactic C5a anaphylatoxin generation.

We investigated in vitro the contents of epidermal cysts for complement activation and found that they activated complement mainly through the alternative pathway. Chemotactic C5a anaphylatoxin produced by the cyst contents after contact with serum most likely plays a significant role in the initiation and aggravation of inflammation in ruptured epidermal cysts. Our additional study disclosed that components of three representative follicular resident microorganisms (Pityrosporum ovale, Propionibacterium acnes, and Staphylococcus epidermidis) also produced C5a anaphylatoxin mainly through the alternative pathway; the C5a production was more vigorous than that by a virulent pathogen, Staphylococcus aureus. These results suggest that accidental colonization of the cyst contents by these follicular microbial flora further augments the inflammatory changes in ruptured epidermal cysts.

Meningitis complicating an occult infected nasal epidermoid cyst in a child.

Congenital nasal epidermoid cyst without associated facial dysmorphism is an uncommon anomaly that is often asymptomatic. We report a case of occult nasal epidermoid cyst in a 12-year-old boy with initial nonspecific symptoms of fever, headache, abdominal pain, vomiting, and diarrhea. An enhanced magnetic resonance imaging (MRI) showed a cystic lesion in the frontal skull base with expansion of the foramen cecum and the perpendicular plate of the ethmoid bone, accompanied with meningitis. An emergent surgical intervention was undertaken, and an infected epidermoid cyst was confirmed by pathology. He recovered uneventfully during a 4-week treatment with parentally-administered antibiotics. This significant case report demonstrates the importance of MRI in the early diagnosis of a life-threatening intracranial infection from an otherwise occult infected congenital nasal epidermoid cyst in children.

Treatment of complicated congenital splenic cysts.

Although rare in occurrence, the potential for congenital splenic cysts to enlarge, rupture, or become infected has been well documented. Presented is the case of a 13-year-old boy with an infected epidermoid cyst of the spleen, which presented as a solitary splenic abscess. The entity has traditionally been treated by splenectomy or, more recently, percutaneous drainage. However, given the inability of percutaneous drainage or sclerotherapy to permanently obliterate congenital splenic cysts, the authors managed this condition with percutaneous drainage and interval partial splenectomy. This achieves complete removal of the lesion while preserving splenic function.

[Rupture of intrascrotal epidermoid cyst complicated by bacterial infection: a case report].

A 63-year-old male visited our hospital with the chief complaint of right scrotal pain. The right scrotum was swollen to the size of a small egg, and its skin was reddish. The mass was palpable independent of the right testis and epididymis. We diagnosed an intrascrotal abscess. The pus spontaneously issued from the scrotal mass. Sequentially, the abscess was extracted under spinal anesthesia. Membrane-like tissue assumed as the abscess wall was removed. Histologically, the abscess wall was composed of epidermal structure with epidermal keratinization, and horny material was found inside the wall. In the scrotal epidermis overlying the abscess, infiltration of neutrophils, lymphocytes, and multinucleated giant cells were observed. Anaerobic bacteria were detected in the pus of the abscess. Consequently, we diagnosed this case as rupture of an intrascrotal epidermoid cyst complicated by bacterial infection.

Penile actinomycosis clinically diagnosed as an epidermal cyst: a case report.

A 27-year-old man presented at our hospital with a 1.5 cm, spherical, soft and movable subcutaneous mass at the mid portion of the ventral aspect of the penile shaft. The possibility of an epidermal cyst was considered and a simple resection was performed. Histologically, the lesion was a unilocular cyst without an epithelial lining, containing eosinophilic necrotic material and a few dispersed scalloped sheets of actinomycotic granules. The centre of the largest granular body demonstrated many fragments of foreign substance. The patient was treated successfully with combined antibiotic therapy.

Un caso inusual de quiste sebáceo infectado por Dermabacter hominis / Unusually infected sebaceous cyst by Dermabacter hominis

La especie Dermabacter hominis está constituida por bacilos gram positivos corineformes, anaerobios facultativos, que forman parte de la microbiota residente de la piel. Excepcionalmente se ha asociado a estos microorganismos con infecciones en pacientes inmunocomprometidos o muy debilitados. Se describe el caso de una mujer adulta joven, inmunocompetente, con un quiste sebáceo en el cuello, infectado por D. hominis como único agente etiológico. Se logró la identificación fenotípica del agente causal mediante pruebas simples basadas en el esquema originalmente propuesto por Funke y Bernard, factibles de ser realizadas en un laboratorio hospitalario de microbiología. Características fenotípicas como la morfología cocoide, el olor acre/espermático, la hidrólisis de la esculina, la producción de pirrolidonil arilamidasa y de lisina y ornitina descarboxilasas son pruebas claves en la identificación de D. hominis. La espectrometría de masas (MALDI-TOF MS) confirmó la identificación fenotípica.

Dermabacter hominis species is constituted by Gram positive facultative anaerobic coryneform rods being part of the resident microbiota human skin, and exceptionally associated to infections in immunocompromised or severely debilitated patients. An immunocompetent young adult woman with a neck sebaceous cyst infected by D. hominis as unique etiologic agent is presented. Phenotypic identification of the causative agent was achieved through simple tests, based on the originally scheme proposed by Funke and Bernard, and feasible to be performed in a hospital Microbiology Laboratory. Phenotypic characteristics as coccoid morphology, the acrid/spermatic odor, esculin hydrolysis, the production of pyrrolidonyl-arylamidase, lysine and ornithine decarboxylase, are key tests to identify D. hominis. The matrix-asisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) confirmed the phenotypic identification.