WHAT’S YOUR DIAGNOSIS? The timing and location of presentation ABOUT THIS CONDITION can easily be mistaken for acne vulgaris, but Steatocystoma lesions are benign and thought steatocystoma lesions are true sebaceous to arise from a mutation in keratin 17. The Skin-Colored Papules on the Chest cysts, which are rare, and spontaneous res- mutation can be inherited in an autosomal olution with increasing age does not typi- dominant pattern, but sporadic nonheritable LT Aaron S. Cantor, MD; LCDR Michael L. Crandall, MD, FAAD; and LCDR Leah K. Spring, DO, FAAD cally occur. The diagnosis of steatocystoma cases are more common.5 There are no dis- often goes unreported because the disease tinct associations with gender or ethnicity. An otherwise healthy male presents with multiple smooth uniform painless cystic papules is usually asymptomatic and mimics more The dermal cysts arise from the sebaceous scattered across his central chest. common benign skin conditions, so an ac- ducts of the pilosebaceous unit, and histo- curate prevalence and incidence are both pathology typically shows numerous mature Aaron Cantor is a General unknown. sebaceous cells encased by a thin wall of strat- Medical Officer at the 2d 25-year-old man presented with multiple uniform painless cystic pap- First on the differential diagnosis is acne ified squamous epithelium.2 Immunohisto- Marine Logistics Group; and Michael Crandall and multiple sternal cysts that he first ules scattered across his central chest that vulgaris, which also presents at puberty and chemical staining for the defective keratin can Leah Spring are Derma- Anoticed when he was aged 18 years were smooth and flesh-colored to slightly affects nearly 85% of adolescents. However, help diagnose biopsy specimens, and histopa- tologists at Naval Medical and had persisted despite treatment with yellow-colored, measuring 2 mm to 6 mm acne is less common in people of Asian or thology confirmed the diagnosis in this case. Center Camp Lejeune, all topical anti-acne agents, including treti- in diameter (Figure). A ring of erythema African descent and may progress along a at Camp Lejeune, North Carolina. noin. No other medications were used. surrounded the lesions that had been re- continuum of increasingly severe and larger TREATMENT Correspondence: The patient was unable to express purulent cently manipulated by the patient. There lesions, including the primary comedones Steatocystoma is usually asymptomatic, so pa- Aaron Cantor (nacrot22@ material from the lesions and reported no were no overlying central puncta, and the and papules followed by pustules, nodules, tients mainly present to physicians for cos- gmail.com) infection or additional trauma to the af- remainder of his body was spared. and pseudocysts. Painful lesions develop metic reasons. Puncturing the cyst wall within fected area. He had no other significant from inflammation of pilosebaceous units the dermis produces translucent sebum- past medical history and no family history concentrated on the face, neck, trunk, upper containing fluid, and ruptured cysts can in- of similar skin lesions. n What is your diagnosis? arms, or buttocks and are typically worse in cite inflammation, pain, and scarring.2 How- A physical examination revealed an males. Resolution often occurs spontane- ever, prognosis is good, and treatment consists otherwise healthy-appearing male with n How would you treat this patient? ously by the third decade of life, but scarring of excision, aspiration and curettage of the cyst can persist.4 wall, oral isotretinoin, or laser therapy. Our pa- FIGURE Painless Skin-Colored Papules Localized to the Central Chest Eruptive vellus hair cysts present as doz- tient elected to forego treatment and will con- ens of skin-colored small (1-4 mm) painless sider definitive removal in the future, since the dome-shaped papules, sometimes with ery- lesions will persist and potentially enlarge. Ac- thema and crusting. Typically these appear curate diagnosis of this rare cause of chest pap- on the head, trunk, or flexor surfaces of in- ules improves the timeliness and efficacy of fants (familial cases) or adolescents (sporadic appropriate treatment, favoring good cosmesis. cases) without bias for gender or ethnic- ity. Although benign and potential mimick- Author disclosures The authors report no actual or potential conflicts of interest ers of steatocystoma and acne, these lesions with regard to this article. can also be associated with more serious syndromes, like ectodermal dysplasias and Disclaimer 2,3 The opinions expressed herein are those of the authors and pachyonychia congenita. do not necessarily reflect those of Federal Practitioner, Front- Epidermoid cysts are common benign line Medical Communications Inc., the US Government, or solitary skin-colored subcutaneous dome- any of its agencies. shaped nodules that contain a central punc- tum through which cheeselike keratinaceous References 4 1. Zuber TJ. Minimal excision technique for epidermoid (se- material can be expressed. These benign le- baceous) cysts. Am Fam Physician. 2002;65(7):1409-1412. sions arising from the dermis can enlarge to 2. du Vivier A. Atlas of Clinical Dermatology. 4th ed. Phila- several centimeters, and adults of both gen- delphia, PA: Elsevier Saunders; 2012. 3. Brinster N, Liu V, Diwan AH, McKee PH. High Yield Pa- DIAGNOSIS Lesions are usually < 2 cm in diameter and ders and most ethnicities tend to develop the thology: Dermatopathology. 1st ed. Philadelphia, PA: El- The patient was diagnosed with steatocys- occur as multiple smooth skin-colored or lesions on the trunk or face, with small cysts sevier Saunders; 2011. 4. Wolff K, Johnson RA, Suurmond D. Fitzpatrick’s Color toma multiplex based on his poor response yellow-colored painless papules on areas with on the face termed milia. Ruptured cysts can Atlas and Synopsis of Clinical Dermatology. 5th ed. New to topical anti-acne agents, the location of his high concentrations of hormonally sensitive incite intense inflammation, and multiple York: McGraw-Hill; 2005. lesions, and histopathology of a biopsy spec- sebaceous glands, especially the chest. Le- epidermoid cysts should raise concern for 5. Gordon Spratt EA, Kaplan J, Patel RR, Kamino H, Ram- 2,3 achandran SM. Steatocystoma. Dermatol Online J. imen. Steatocystoma multiplex, sometimes sions also can be found in the axillae and on Gardner syndrome. 2013;19(12):20721. termed sebocystomatosis, typically presents the neck.1-3 Solitary lesions can occur and are between puberty and the third decade of life. termed steatocystoma simplex. 38 • FEDERAL PRACTITIONER • NOVEMBER 2018 mdedge.com/fedprac mdedge.com/fedprac NOVEMBER 2018 • FEDERAL PRACTITIONER • 39.