Epidermoid Cyst, No Infection

An epidermoid cyst is a small abnormal growth in the top layers of the skin. It’s filled with keratin, the same proteins that make up your hair and nails. An epidermoid cyst may incorrectly be called a sebaceous cyst.

Some general facts about epidermoid cysts:

• An epidermoid cyst is a sac filled with material from skin secretions. It can grow anywhere on the body. But it’s most often found on the face, behind the ears, and on the chest or upper back. It often has an open, enlarged pore in the middle of it.

• The material in the cyst is often cheesy, fatty, or oily. The material can be thick (like cottage cheese) or liquid.

• The area around the cyst may smell bad. If the cyst breaks open, the material inside it often smells bad too.

• The cyst is usually firm and you can usually move it slightly if you try.

• The cyst can be smaller than a pea or as large as a few inches.

• It’s usually not painful, unless it becomes inflamed or infected.

Causes

Epidermoid cysts are caused when skin (epidermal) cells move under the skin surface, or are covered over by it. These cells continue to multiply, like skin does normally. They then form a wall around themselves (cyst) and secrete normal skin material (keratin). In most cases, epidermoid cysts occur for no known reason. They may also occur because of an injury to the skin or from acne

Symptoms

Symptoms of an epidermoid cyst include:

• Feeling a lump just beneath the skin

• It may or may not be painful

• The cyst may or may not smell bad

• The cyst may become inflamed or red

• The cyst may leak fluid or thick material

Home care

Epidermoid cysts often go away without any treatment. If your cyst doesn’t go away, and it bothers you, it may be drained or removed. If the cyst drains on its own, it may return. Resist the temptation to squeeze, pop, stick a needle in it, or cut it open. This often leads to an infection and scarring. If it gets severely inflamed or infected, seek medical care. Be sure to clean the cyst area when bathing or showering. Watch for the signs of infection listed below.

Follow-up care

Follow up with your healthcare provider, or as advised.

When to get medical advice

Call your healthcare provider right away if any of these occur:

• Swelling, redness, or pain

• Pus coming from the cyst

• Fever of 100.4°F (38ºC) or higher, or as advised by your provider

© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

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Acne Conglobata – StatPearls – NCBI Bookshelf

Continuing Education Activity

Acne conglobata (AC) is a rare but severe form of nodulocystic acne. It usually presents with tender, disfiguring, double or triple interconnecting comedones, cysts, inflammatory nodules, and deep burrowing abscesses on the face, shoulders, back, chest, upper arms, buttocks, and thighs. The comedones often occur in groups of three, and the cysts often contain purulent, foul-smelling material that is discharged on the skin surface. It is a chronic inflammatory disease that inevitably leads to scar formation and disfigurement. Acne conglobata may occur following the sudden worsening of pustular acne, or the disorder may occur gradually following the recrudescence of acne that has been quiet for many years.[2][3][4] This activity reviews the evaluation and management of acne conglobata and highlights the role of the interprofessional team in evaluating and improving care for patients with this condition.

Objectives:

• Describe how acne conglobata differs from acne fulminans.

• Explain the etiology of acne conglobata.

• Outline the treatment of choice for acne conglobata.

• Identify strategies that interprofessional team members can utilize to improve evaluation, management, and counseling for patients with acne conglobata.

Access free multiple choice questions on this topic.

Introduction

Acne conglobata (AC) is a rare but severe form of nodulocystic acne. It usually presents with tender, disfiguring, double or triple interconnecting comedones, cysts, inflammatory nodules, and deep burrowing abscesses on the face, shoulders, back, chest, upper arms, buttocks, and thighs. The comedones often occur in groups of three, and the cysts often contain purulent, foul-smelling material that is discharged on the skin surface. It is a chronic inflammatory disease that inevitably leads to scar formation and disfigurement.[1] Acne conglobata may occur following the sudden worsening of pustular acne, or the disorder may occur gradually following the recrudescence of acne that has been quiet for many years. [2][3][4]

Acne conglobata is part of the follicular occlusion tetrad, a group of related diseases involving dysfunction of the follicular unit, including dissecting cellulitis, pilonidal disease, and hidradenitis suppurativa (HS). The follicular occlusion tetrad can be exceptionally difficult to treat. Whereas ordinary acne vulgaris can typically be managed with topical agents, AC requires aggressive treatment due to the degree of inflammation and formation of deep nodules and cysts.[1]

Acne conglobata may occur in isolation or present with a systemic inflammatory condition, including SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis), PAPA syndrome (pyogenic arthritis, pyoderma gangrenosum, acne), PASH syndrome (pyoderma gangrenosum, acne, suppurative hidradenitis), or PAPASH syndrome (pyogenic arthritis, pyoderma gangrenosum, acne, suppurative hidradenitis).[5] The sudden onset of severe acne with oozing and ulcerative lesions in relation to these syndromes or with respect to isotretinoin use is called acne fulminans, an immunologically induced systemic inflammatory response that may have accompanying fevers, malaise, and weight loss. Acne fulminans may arise from pre-existing AC lesions in a patient or may arise entirely de novo after initiation of isotretinoin therapy or concerning anabolic steroid use.[1]

Etiology

The etiology of acne involves the interplay of multiple factors, including follicular hyperkeratinization, hormonally-induced sebum production, and inflammation. The gram-positive microaerophilic/anaerobic rod called Cutibacterium acnes (formerly Propionibacterium acnes) is a commensal organism of the skin found deep within the sebaceous follicle and mediates a portion of the inflammatory component.[6]

The precursor of all acne lesions is the microcomedo. Increased follicular keratinocyte proliferation and cohesiveness lead to the accumulation of keratinocytes within the upper portion of the hair follicle rather than being shed and extruded as normal. This creates a follicular plug and bottleneck behind which additional keratinocytes and sebum build up within the follicle. Further accumulation of keratin and sebum leads to the formation of a comedo which develops into an inflammatory papule. Rupture of the follicular wall leads to intense inflammation and the formation of a nodule or cyst. Acne conglobata lies at the extreme end of the acne spectrum with many interconnecting comedones, cysts, inflammatory nodules, and draining sinus tracts. These can frequently become secondarily infected.[7]

Sebaceous glands are controlled principally by androgens such as testosterone, 5a-dihydrotestosterone (DHT), and dehydroepiandrosterone (DHEA). Receptors for these hormones are found in the cells of the sebaceous gland and outer root sheath of the hair follicle, and increased levels of circulating hormones seen with the onset of puberty lead to a rise in sebum production.[8] Persons with acne tend to have higher production of sebum overall as well as a different composition of the sebum they produce. They have higher levels of squalene, which form oxidative products, and lower levels of linoleic acid, the reduction of which predisposes to comedo formation and increased epidermal permeability by inflammatory substances. [9]

The role of Cutibacterium acnes in the pathogenesis of acne vulgaris has been under much study in recent years. Previously, it was believed that an overgrowth of C. acnes led to acne formation, but studies have found that the quantity of C. acnes on the skin is no difference between those with acne and those without.[6] Rather, research suggests that the specific strain or subtype of C. acnes prevalent in the follicles mediates the inflammatory response in acne formation. Subtypes II and III are believed to play a protective role in the normal microbiome of the skin, but Subtype I appears to be pathogenic when out of balance with the other two subtypes.[10][11] Individuals who develop acne conglobata likely have significant dysbiosis and an inflammatory reaction to Subtype I above and beyond that normally seen in acne-prone skin, although the specific reason for that is unknown.[12][13][14]

Ingestion of thyroid medication and exposure to halogenated aromatic hydrocarbons may trigger acne conglobata. Other factors that can provoke acne conglobata include androgens (e.g., androgen-producing tumors) and anabolic steroids.[1]

Acne conglobata has also been reported to occur in individuals who stop anabolic hormones or as a reaction to other hormonal agents.

Some people with acne conglobata have the XYY karyotype.

Epidemiology

Acne conglobata is not very common. Overall, it is more common in men than women. Over the past 30 years, many reports have been published on athletes with this type of acne, which is felt to be primarily due to the use of anabolic steroids. Outside the US, not much is known about acne conglobata. The condition is usually seen in young adults and very rarely seen in children or older adults. The onset is usually in the second and third decades of life. Whether it occurs more frequently in any specific race is not known.[15]

Pathophysiology

Acne conglobata presents with deep burrowing abscesses that interconnect with each other via sinus tracts. Initially, the nodular lesion may mimic a pimple, but underneath there is a vigorous inflammatory reaction and pus formation. Over time, the pus pushes into the adjacent tissues and extrudes on the skin’s surface. Scar formation and disfigurement of the body are common with this type of acne. The comedones often occur in groups of three, and the cysts often contain purulent, foul-smelling material discharged on the skin surface.

History and Physical

Acne conglobata is a rare but severe form of nodulocystic acne. It usually presents with tender, disfiguring, double or triple interconnecting comedones, cysts, inflammatory nodules, and deep burrowing abscesses on the face, shoulders, back, chest, upper arms, buttocks, and thighs. The comedones often occur in groups of three, and the cysts often contain purulent, foul-smelling material that is discharged on the skin surface. It is a chronic inflammatory disease that inevitably leads to scar formation and disfigurement. Acne conglobata may occur following the sudden worsening of pustular acne, or the disorder may occur gradually following the recrudescence of acne that has been quiet for many years.

A physical exam will usually reveal a severe form of acne. The nodular lesions are tender and dome-shaped. When the nodules have broken down, there will be the presence of discharge that is foul-smelling pus. After the pus has drained, crusting of the lesion is common, followed by the formation of large irregular scars.

A classic feature of the disorder is the presence of paired or aggregates of blackheads on the trunk, neck, upper arms, and buttocks.

Acne conglobata may follow the use of androgenic anabolic steroids and is quite common in bodybuilders. Many young adult males will present to the dermatology clinic complaining of severe acne and facial scars. It is important to seek a thorough history of the use of anabolic steroids because discontinuation of these agents is vital for treatment.

Acne conglobata may also occur in patients with hidradenitis suppurativa and pyoderma gangrenosum. When the condition develops following puberty, the nodules will gradually coalesce and increase in severity over the ensuing years. Active nodule formation usually persists for the first three decades of life and then becomes quiescent.

Evaluation

The diagnosis is made clinically, and the discharge should be cultured. Appropriate antibiotics should be started in the presence of putrid discharge, as discussed below (e.g., minocycline or doxycycline). One should not wait for culture results before starting antibiotic therapy.

Treatment / Management

The treatment of choice for acne conglobata is using retinoids like isotretinoin for 20 to 28 weeks or, in some cases, even longer. Consider adding oral prednisone (1 mg/kg/d) for 14 to 28 days upon starting isotretinoin. Steroids have been shown to be effective if acne flares during the initiation of isotretinoin or when there are systemic constitutional symptoms. The sudden onset of severe acne with oozing and ulceration in relation to isotretinoin use is called acne fulminans, an immunologically induced systemic response that may have accompanying fevers, malaise, anorexia, and weight loss. In such cases, isotretinoin should be temporarily stopped while prednisone is used for 2 to 4 weeks, then isotretinoin can be restarted slowly (0.1 mg/kg/day) while continuing prednisone an additional four weeks, after which isotretinoin is tapered up while prednisone is tapered down.[16][17]

Topical retinoids are not as effective as oral retinoids but can be used adjunctively. It is important not to administer retinoids to women of childbearing age in the absence of effective contraception, as these drugs are known to be teratogenic.[18][19]

• Other options include the use of minocycline or doxycycline at 100 mg twice daily. These tetracyclines should not be combined with oral isotretinoin because there is a potential to induce pseudotumor cerebri.[1]

• Dapsone dosed at 50 to 150 mg daily is an option if unresponsive, although care must be taken with lab monitoring for methemoglobinemia, G6PD deficiency, and agranulocytosis.[20]

• Therapy with TNF-alpha inhibitors infliximab, adalimumab, and etanercept is supported in some case reports. These may be particularly helpful when acne conglobata arises as part of the follicular occlusion tetrad.[18]

• Laser therapy with fractional and ablative carbon dioxide laser, Nd:YAG, and vascular laser has shown efficacy in a few case reports.[21]

• In severe cases of acne conglobata that do not respond to the above treatments, another option is external beam radiation.[22]

Surgery

• When nodules are large and fluctuant, they can be aspirated. Sometimes providers may use cryotherapy or intralesional triamcinolone. The large nodules can also be excised surgically.

• Once the lesions have healed, dermal fillers can be used to improve the scars. In 2015 the FDA approved using the bovine collagen filler to treat acne scarring. Other dermal fillers and biostimulators can be used as well.

Differential Diagnosis

The differential diagnoses of acne conglobata include but are not limited to the following:

• SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis)

• PAPA syndrome (pyogenic arthritis, pyoderma gangrenosum, acne)

• PASH syndrome (pyoderma gangrenosum, acne, suppurative hidradenitis)

• PAPASH syndrome (pyogenic arthritis, pyoderma gangrenosum, acne, suppurative hidradenitis)

• Acne fulminans

• Acne vulgaris

• Acneiform papulonodules

• Bromoderma

• Iododerma

• Rosacea fulminans

Prognosis

Acne conglobata can produce marked disfigurement. Severe scarring causes psychological impairment; individuals with acne conglobata often feel excluded. Acne conglobata has also been responsible for anxiety and depression in many patients.

Complications

Most patients with acne conglobata are shy and embarrassed about their skin condition. Many give a history of being withdrawn and isolated. Suicidal ideations are also common in this population. Thus, it is vital to offer them mental health counseling and referral to their primary care physician or psychiatrist to manage depression.

Deterrence and Patient Education

Once the diagnosis of acne conglobata is made, these individuals should receive psychological counseling because of depression and anxiety resulting from body disfigurement. The tendency is for these patients to hide the body disfigurement and skin lesions with garments, often leading to excess warmth and humidity, which worsens the skin condition. Hence, patient education on skin hygiene and counseling is recommended.

Enhancing Healthcare Team Outcomes

Patients with acne usually present to their primary care provider. But these clinicians should be aware that there are types of acne that are very serious and need an appropriate consult with a dermatologist. Acne conglobata is best managed by a dermatologist leading an interprofessional team that also includes nurses and pharmacists, as it requires more aggressive therapy with close follow-up.

In patients with acne conglobata, significant disfigurement is common, and the scarring often results in psychological impairment and social isolation. Many people with acne conglobata develop depression and anxiety. Once the diagnosis is made, these individuals should receive psychological counseling. The tendency is for these patients to hide the body disfigurement and skin lesions with garments, often leading to excess warmth and humidity, which worsens the skin condition. Hence, clinicians and nurses should educate the patient on skin hygiene and recommend counseling. In more severe cases, starting these patients on antidepressants and anti-anxiety medications can also be helpful.[23] [Level 5]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Acne Conglobata on back and shoulders. Contributed by Chelsea Rowe

References

1.

Greydanus DE, Azmeh R, Cabral MD, Dickson CA, Patel DR. Acne in the first three decades of life: An update of a disorder with profound implications for all decades of life. Dis Mon. 2021 Apr;67(4):101103. [PubMed: 33041056]

2.

Al-Kathiri L, Al-Najjar T. Severe Nodulocystic Acne not Responding to Isotretinoin Therapy Successfully Treated with Oral Dapsone. Oman Med J. 2018 Sep;33(5):433-436. [PMC free article: PMC6131924] [PubMed: 30210724]

3.

Borgia F, Vaccaro M, Giuffrida R, Cannavò SP. Photodynamic therapy for acne conglobata of the buttocks: Effective antiinflammatory treatment with good cosmetic outcome. Indian J Dermatol Venereol Leprol. 2018 Sep-Oct;84(5):617-619. [PubMed: 30073983]

4.

Sotoodian B, Kuzel P, Brassard A, Fiorillo L. Disfiguring ulcerative neutrophilic dermatosis secondary to doxycycline and isotretinoin in an adolescent boy with acne conglobata. Cutis. 2017 Dec;100(6):E23-E26. [PubMed: 29360905]

5.

Garcovich S, Genovese G, Moltrasio C, Malvaso D, Marzano AV. PASH, PAPASH, PsAPASH, and PASS: The autoinflammatory syndromes of hidradenitis suppurativa. Clin Dermatol. 2021 Mar-Apr;39(2):240-247. [PubMed: 34272017]

6.

Segre JA. What does it take to satisfy Koch’s postulates two centuries later? Microbial genomics and Propionibacteria acnes. J Invest Dermatol. 2013 Sep;133(9):2141-2. [PMC free article: PMC3775492] [PubMed: 23842116]

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Jeremy AH, Holland DB, Roberts SG, Thomson KF, Cunliffe WJ. Inflammatory events are involved in acne lesion initiation. J Invest Dermatol. 2003 Jul;121(1):20-7. [PubMed: 12839559]

8.

Lucky AW, Biro FM, Huster GA, Leach AD, Morrison JA, Ratterman J. Acne vulgaris in premenarchal girls. An early sign of puberty associated with rising levels of dehydroepiandrosterone. Arch Dermatol. 1994 Mar;130(3):308-14. [PubMed: 8129408]

9.

Powell EW, Beveridge GW. Sebum excretion and sebum composition in adolescent men with and without acne vulgaris. Br J Dermatol. 1970 Mar;82(3):243-9. [PubMed: 4245905]

10.

Dréno B, Dagnelie MA, Khammari A, Corvec S. The Skin Microbiome: A New Actor in Inflammatory Acne. Am J Clin Dermatol. 2020 Sep;21(Suppl 1):18-24. [PMC free article: PMC7584556] [PubMed: 32910436]

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Schneider AM, Nolan ZT, Banerjee K, Paine AR, Cong Z, Gettle SL, Longenecker AL, Zhan X, Agak GW, Nelson AM. Evolution of the facial skin microbiome during puberty in normal and acne skin. J Eur Acad Dermatol Venereol. 2023 Jan;37(1):166-175. [PubMed: 36165604]

12.

Balakirski G, Neis MM, Megahed M. Acne conglobata induced by adalimumab. Eur J Dermatol. 2017 Jun 01;27(3):320-321. [PubMed: 28524046]

13.

Inoue CN, Tanaka Y, Tabata N. Acne conglobata in a long-term survivor with trisomy 13, accompanied by selective IgM deficiency. Am J Med Genet A. 2017 Jul;173(7):1903-1906. [PubMed: 28480529]

14.

Dessinioti C, Katsambas A. Difficult and rare forms of acne. Clin Dermatol. 2017 Mar-Apr;35(2):138-146. [PubMed: 28274350]

15.

Scheinfeld N. Diseases associated with hidranitis suppurativa: part 2 of a series on hidradenitis. Dermatol Online J. 2013 Jun 15;19(6):18558. [PubMed: 24011308]

16.

Fakih A, Goens J, Grozdev I, Dangoisse C, Richert B. Acne fulminans induced by a low dose isotretinoin: case report and review of the literature. Dermatol Online J. 2020 Dec 15;26(12) [PubMed: 33423422]

17.

Greywal T, Zaenglein AL, Baldwin HE, Bhatia N, Chernoff KA, Del Rosso JQ, Eichenfield LF, Levin MH, Leyden JJ, Thiboutot DM, Webster GF, Friedlander SF. Evidence-based recommendations for the management of acne fulminans and its variants. J Am Acad Dermatol. 2017 Jul;77(1):109-117. [PubMed: 28619551]

18.

Yiu ZZ, Madan V, Griffiths CE. Acne conglobata and adalimumab: use of tumour necrosis factor-α antagonists in treatment-resistant acne conglobata, and review of the literature. Clin Exp Dermatol. 2015 Jun;40(4):383-6. [PubMed: 25545016]

19.

Sand FL, Thomsen SF. Adalimumab for the treatment of refractory acne conglobata. JAMA Dermatol. 2013 Nov;149(11):1306-7. [PubMed: 24048280]

20.

Searle T, Al-Niaimi F, Ali FR. Dapsone for acne: Still in use after half a century! J Cosmet Dermatol. 2021 Jul;20(7):2036-2039. [PubMed: 33600049]

21.

Kalashnikova NG, Albanova VI, Jafferany M. Laser treatment of acne conglobatа with concomitant oral isotretinoin use. Dermatol Ther. 2021 Jan;34(1):e14553. [PubMed: 33205848]

22.

Myers JN, Mason AR, Gillespie LK, Salkey KS. Treatment of acne conglobata with modern external beam radiation. J Am Acad Dermatol. 2010 May;62(5):861-3. [PubMed: 19665259]

23.

Harth W, Hillert A, Hermes B, Seikowski K, Niemeier V, Freudenmann RW. [Suicidal behavior in dermatology]. Hautarzt. 2008 Apr;59(4):289-96. [PubMed: 18338146]

Disclosure: Wissem Hafsi declares no relevant financial relationships with ineligible companies.

Disclosure: David Arnold declares no relevant financial relationships with ineligible companies.

Disclosure: Michael Kassardjian declares no relevant financial relationships with ineligible companies.

Pimples smell bad

• Causes of bad smell from pimples
• Subcutaneous pimple with malodor
• How to get rid of bad smell pimples

According to the American Academy of Dermatology and Acne, acne is the most common and complex inflammatory skin disease that affects at least 50 million American adults and adolescents The inflammatory condition involves a malfunction of the skin’s sebaceous glands that become clogged with dead skin cells and excess oil, trapping bacteria in the pores This causes an inflammatory response and leads to the development of acne, some of which contain pus for by-products of bacteria that feed on skin oil.

Acne odor causes

Acne bacteria

A type of bacteria called Propionibacterium acnes (P acnes) usually lives deep in the oily pores of the skin because it feeds on sebum, also known as sebum People with acne usually have an overgrowth of P acnes, likely due to excess sebum production people with acne also have an exaggerated immune response to P acnes, leading to inflammation of the pores and accumulation of white blood cells. The inflammatory response to trapped bacteria, as well as the accumulation of sebum, dead skin cells, and white blood cells in the pores, leads to pus. In people with moderate to severe acne, these pimples can grow into larger nodules or cysts and even take on the smell of a pimple.

Odor associated with bacteria:

Many types of bacteria release odors as they grow. These odors come from by-products derived from bacteria that feed on various substances. P acnes has specialized enzymes that allow bacteria to break down and feed on sebum. This test results in the formation of propionic acid and chemicals called short chain fatty acids. , side effects from the breakdown of P acnes skin oil give off an odor that many patients describe as a bitter or sour body odor.

Types of bacteria that infect a pimple and cause bad breath

There are different types of bacteria that can harm hair follicles, causing clogged pores that can result in zit These different types of bacteria have a completely different effect on how these odors smell Aerobic bacteria dependent on the growth of oxygen usually do not cause bad breath with zit rot, in while those anaerobic bacteria that produce sulfur can lead to zit malodor.

Bacteria are commonly present on the skin and some of them are beneficial But harmful bacteria such as Staphylococcus aureus can also be present Blocked pores provide a breeding ground for bacteria and can become infected as the bacteria attack the biological building materials in them Smell is unlikely to be very noticeable

Pimple pus odor

When small, common pimples secrete a small amount of pus, you are unlikely to notice any odor. In this case, the amount of odor-releasing chemicals is usually too low to cause a noticeable odor. However, because the large dead cell nodules and cysts contain a large amount of pus and bacterial debris, you may experience an unpleasant odor from these types of pimples as well.

Dead skin cells

As new skin cells develop in the dermis, old skin cells are forced out. The outermost layer of skin cells, the stratum corneum, is composed of about 20 layers of dead skin cells, which gradually slow down. the problem of the unpleasant smell of pus from acne.

Although the foul odor associated with a purulent discharge usually affects heavily infected skin that contains a large amount of pus, this is not a major problem for your health. Instead of trying to determine what your pimple smells like, it is better to carefully monitor the symptoms of the development of a skin disease and explain the entire course of the disease to a dermatologist as accurately as possible in the future.

Subcutaneous pimple with an unpleasant odor

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A foul-smelling subcutaneous pimple usually presents as a sebaceous cyst, a small lump of fat and pus under the skin. This type of cyst is not cancerous.

They are most commonly found on the face, neck, and upper back, but can also occur on other areas of the body.

A sebaceous cyst usually grows very slowly and does not cause pain.

However, they may become inflamed or infected, with the overlying skin becoming red, tender, and painful to the touch.

How to Get Rid of Bad Smell Acne

Most of the recommended acne treatments directly or indirectly reduce the overgrowth of P.acnes in the sebaceous glands, thereby reducing the likelihood of pus odor. Topical benzoyl peroxide products, for example, kill some of the P.acnes on the skin.

These products are recommended for use either alone or in combination with other acne treatments Oral antibiotic therapy also reduces P.acnes populations and is recommended for some people with acne Topical retinoids such as tretinoin (Retin-A), adapalene (Differin), and tazarotene (Tazorac), in gel or lotion form.

Zits or foul-smelling pimples are usually more common in men, although women can also experience them. Although this skin breakout usually occurs on the facial skin, zits can also spread throughout the skin of the body Zits are always filled with pus, which is usually a solid white or yellow color Pus are dead white blood cells that fight infecting bacteria As anaerobic bacteria, these bacteria do not require oxygen to survive Instead In doing so, they produce their own sulfur compounds as they grow and spread through the internal channels of the skin.

A strong odor can be seen if the zit is infected with an anaerobic type of bacteria. On the other hand, bacteria that grow and spread with oxygen usually do not cause an unpleasant odor. A mild zit problem usually does not lead to this malodor, while a severe infection tends to end in an odor, as the body produces more of the pus contained in the zit.

The stronger the smell, the more likely the zit is to be contagious. This means that if you find a foul odor, the infecting bacteria will enter other skin pores, causing another similar pimple. Therefore, it is important to clean any purulent zit to prevent further infection and bacterial invasion. Therefore, it is important to clean any purulent boil to prevent further infection and bacterial invasion.

Atheroma – what is it and how is it treated?

Atheroma is an epidermal or follicular cyst filled with a pasty substance or the cyst’s own secretions.

That is, it is a subcutaneous capsule containing a curd mass. This curdled mass is the accumulated secretions of the sebaceous gland, which often have an unpleasant odor. Sometimes there is a hole in the middle of the formation, from which the contents of an unpleasant color and smell are released. Sometimes atheromas are multiple.

Causes of atheroma?

There are many reasons for the appearance of atheromas. Most often, atheroma occurs due to blockage of the excreted duct of the duct of the sebaceous gland or swelling of the hair follicle (sac). swelling of the follicle may occur due to damage. As a rule, one hair grows from one follicle (hair follicle), and after injury and hair removal, the exit from the follicle can be blocked, especially against the background of high testosterone levels. The remaining part of the sebaceous gland continues to secrete sebaceous secretions and, as a result, the former follicle increases in size and turns into a large atheroma. Injury or rupture of the sebaceous glands themselves. Part of such a gland after an injury or inflammatory process (furuncle or carbuncle) may be under the skin, and since the gland continues to work and secrete a sebaceous secret, atheroma appears. The appearance of atheromas can also be influenced by hereditary and hormonal factors, such as increased testosterone levels.

What’s inside an atheroma?

Contents of atheroma are filled with secretions, usually sebaceous glands. As a rule, these are fatty and keratinized substances of a fibrous structure. Outwardly, this mixture resembles cottage cheese. If an infection has penetrated into the atheroma, then the contents turn into a purulent mass of various colors from white to brown and mixed with blood.

Who gets atheromas more often?

Atheromas are very common and in most people throughout life, at least one appears. They appear for no apparent reason. True, it is believed that men appear twice as often. By age – the peak of the appearance of atheromas occurs at 20-30 years, but people go to the doctor more often at a later age, when atheromas grow to an impressive size.

On which part of the body do atheromas appear more often?

Atheromas are most often found on the scalp, face, ears, neck, shoulders, back and chest. In men, atheromas occur on the scrotum. On the scalp, if the atheroma is for a long time, this can lead to hair loss in this area, directly above the atheroma.

What is the danger of atheroma?

Atheromas are benign neoplasms (not cancerous), but they can become a chronic source of infection, which leads to other complications. Atheroma, even if not infected with a bacterial infection, can become inflamed and swollen. During inflammation, atheroma is very difficult to remove, so the operation during such a period may be postponed. Serious complications of atheroma are its rupture and infection, which can lead to an abscess and even phlegmon. Very rarely, atheromas can lead to basal and squamous cell skin cancer, but since this rarely occurs, atheroma histological examination is not performed.

How do you know if atheroma is inflamed and infected?

Signs and symptoms indicating inflammation of atheroma: reddening of the skin over the atheroma, swelling, increase in size, pain, aggravated by touch, fever, discharge of a white-gray substance over the atheroma with an unpleasant odor. If a person has at least one of the listed signs, then an urgent need to consult a surgeon.

When contacting a surgeon

The doctor will conduct a survey, examination, make an accurate diagnosis. For the diagnosis of atheroma, ultrasound, consultation with an oncologist or dermatologist is sometimes required. After the diagnosis is made, the doctor will prescribe the appropriate treatment. If it is a surgical treatment, he will tell you how it will be carried out: to what extent, by what method, under what anesthesia. Be sure to ask about the tolerance of drugs, allergies, the presence of concomitant diseases, such as diabetes, taking drugs that affect the blood coagulation system. The latter may be a contraindication to surgery. In accordance with generally accepted treatment protocols, he will prescribe a preoperative laboratory examination. After that, he will set the date of the operation or hold it on the day of the appeal, if possible.

How many days to stay in the hospital

The operation is usually performed on an outpatient basis and usually does not require hospitalization in most cases.

How long will the atheroma removal operation take? The operation to remove atheroma is usually performed on an outpatient basis, under local anesthesia. The duration of the actual surgical intervention is 15-25 minutes, but the total time taken together with preparation, followed by dressing, paperwork is 45-70 minutes.

What kind of anesthesia is used to remove atheroma?

Removal of atheroma in most cases is performed under local anesthesia. The use of anesthesia is irrational. Local anesthesia is the introduction of an anesthetic using a syringe with a needle into the skin and subcutaneous tissue surrounding and covering the atheroma, or more simply, an anesthetic injection is made. General anesthesia, that is, anesthesia or regional conduction anesthesia, is carried out if there are indications, for example, with a giant atheroma.

Before the operation

On the day of the operation, 4 hours before the actual operation, it is advisable not to eat or drink anything. Before the operation itself, consent to the surgical intervention is signed and the place where the atheroma is located is photographed.

Emergency surgical treatment for atheroma inflammation

If an atheroma has become infected, inflamed and an abscess has formed, then it is not possible to remove the atheroma. In this case, under sterile conditions under local anesthesia, the atheroma is opened, the purulent contents are evacuated, washed and drained. In the postoperative period, antibiotics are often required. Further, the wound is tightened according to the laws of purulent surgery, the so-called secondary intention. In this case, the atheroma will need to be removed after 3 months to avoid recurrence of inflammation.

Elective surgical treatment

Elective surgery, as a rule, takes place according to the following algorithm:

1. Preparation and treatment of the surgical field with disinfectants.
2. Anesthetize the area around the atheroma with local anesthetics.
3. An incision is made over the atheroma An incision in modern medical institutions can be made both with a scalpel and with a radio wave knife Surgitron (Surgitron) or a laser.
4. Next, the atheroma is isolated and husked. Atheroma can be removed in two different ways: without violating the membranes as a whole, or with the extraction of the contents of the atheroma in the first place and the membranes in the second. The latter method is used if a small skin incision is made or the atheroma is fragmented.
5. Next, hemostasis is carried out – that is, they stop bleeding from damaged vessels, if any.
6. Treat the wound with disinfectants.
7. Stitch the wound if required. Depending on where the atheroma was located, absorbable, cosmetic, ordinary or reinforced sutures are applied (especially on parts of the body that are actively involved in the movement of the body, for example, in the armpits and on the lower back).
8. Apply an aseptic bandage to the wound or a sticker, depending on the location of the former atheroma. For small incisions or on the scalp, do not apply a bandage.

Will there be a scar after the operation?

In the incision area, immediately after the operation, a small scar remains, which should disappear with time. How long it will disappear – it depends on the individual characteristics of the organism.

What complications can occur after the operation?

After removal of atheroma, tissue fluid with blood clots may accumulate in the resulting cavity. The danger of the accumulation of this fluid is that this fluid is a potentially ideal environment for the development of infection. To prevent this fluid from accumulating, a pressure bandage or drains are applied, through which this fluid flows out over the next day and thereby prevents the formation of an infectious focus.

After removal of atheroma during the first day, there may be a slight increase in body temperature. But if the temperature rises to a high level (38 g), swelling and pain occur in the area of ​​the postoperative wound, then you should urgently contact the surgeon who performed the operation to prevent infection from entering the postoperative wound, even though inflammation and infection of the postoperative wound is rare.