What are epidermoid cysts. How do epidermoid cysts form. What are the common symptoms of epidermoid cysts. When should you seek medical attention for an epidermoid cyst. What are the treatment options for epidermoid cysts.

Understanding Epidermoid Cysts: An Overview

Epidermoid cysts are small, abnormal growths that develop in the top layers of the skin. These benign formations are filled with keratin, the same protein that makes up hair and nails. While often mistakenly referred to as sebaceous cysts, epidermoid cysts have distinct characteristics and origins.

Key Features of Epidermoid Cysts

• Typically appear as small, round bumps under the skin
• Can occur anywhere on the body, but most common on the face, behind the ears, chest, and upper back
• Often have an enlarged, open pore in the center
• Contain cheesy, fatty, or oily material that may have an unpleasant odor
• Usually firm to the touch and slightly movable
• Can range in size from smaller than a pea to several inches in diameter
• Generally painless unless inflamed or infected

The Formation and Causes of Epidermoid Cysts

Epidermoid cysts form when epidermal cells move beneath the skin surface or become covered by it. These cells continue to multiply as they would normally, creating a wall around themselves and secreting keratin. But what causes this process to occur?

Common Causes of Epidermoid Cysts

• Spontaneous development with no known reason
• Skin injuries
• Acne

In most cases, epidermoid cysts appear without any apparent cause. However, skin trauma or acne can sometimes trigger their formation. Understanding these causes can help in prevention and early detection.

Recognizing the Symptoms of Epidermoid Cysts

Identifying an epidermoid cyst early can lead to better management and treatment outcomes. What are the telltale signs of an epidermoid cyst?

Common Symptoms to Watch For

• A noticeable lump just beneath the skin
• Potential pain or discomfort
• Unpleasant odor from the cyst area
• Inflammation or redness around the cyst
• Leakage of fluid or thick material from the cyst

It’s important to note that not all epidermoid cysts will exhibit all these symptoms. Some may be completely asymptomatic, while others might cause significant discomfort.

Home Care and Management of Epidermoid Cysts

Many epidermoid cysts resolve on their own without any intervention. However, if a cyst persists and causes discomfort, there are several home care strategies you can employ.

Effective Home Care Techniques

• Maintain proper hygiene by cleaning the cyst area regularly during bathing or showering
• Avoid squeezing, popping, or attempting to drain the cyst yourself
• Monitor the cyst for signs of infection or severe inflammation
• Apply warm compresses to relieve discomfort and potentially encourage natural drainage

Remember, while home care can be effective, it’s crucial to know when professional medical attention is necessary.

When to Seek Medical Attention for Epidermoid Cysts

While many epidermoid cysts are harmless and can be managed at home, certain situations warrant professional medical care. But how do you know when it’s time to consult a healthcare provider?

Signs That Require Medical Attention

• Increased swelling, redness, or pain around the cyst
• Pus discharge from the cyst
• Fever of 100.4°F (38°C) or higher
• Rapid growth of the cyst
• Cyst location interfering with daily activities

If you experience any of these symptoms, it’s crucial to seek medical advice promptly. Early intervention can prevent complications and ensure proper treatment.

Treatment Options for Epidermoid Cysts

When home care isn’t sufficient, or when a cyst becomes problematic, several medical treatments are available. What are the most common approaches to treating epidermoid cysts?

Professional Treatment Methods

1. Drainage: A minor procedure where the cyst is cut and drained of its contents. This provides immediate relief but doesn’t remove the cyst wall, so recurrence is possible.
2. Complete Surgical Excision: The entire cyst, including its wall, is surgically removed. This method has the lowest chance of recurrence.
3. Laser Therapy: In some cases, laser treatment can be used to vaporize the cyst.
4. Medication: If infection is present, antibiotics may be prescribed.

The choice of treatment depends on factors such as the cyst’s size, location, and whether it’s infected. Your healthcare provider will recommend the most suitable option based on your individual case.

Preventing Epidermoid Cysts: Is It Possible?

While it’s not always possible to prevent epidermoid cysts, especially those that occur spontaneously, there are steps you can take to reduce your risk. But what are these preventive measures?

Strategies for Reducing Epidermoid Cyst Risk

• Maintain good skin hygiene to prevent blocked pores
• Treat acne promptly and effectively
• Avoid picking at or squeezing existing pimples or cysts
• Protect your skin from injuries when possible
• Use non-comedogenic skincare products to prevent pore blockage

While these strategies can help, it’s important to remember that some people may be more genetically predisposed to developing epidermoid cysts. In such cases, early detection and proper management become crucial.

The Impact of Epidermoid Cysts on Quality of Life

While epidermoid cysts are generally benign, they can significantly impact an individual’s quality of life. How do these cysts affect people beyond their physical symptoms?

Psychological and Social Effects

• Self-consciousness or embarrassment, especially if cysts are visible
• Anxiety about potential growth or infection of the cyst
• Discomfort in social situations due to the cyst’s appearance or odor
• Limitations in physical activities if the cyst is in a sensitive area

Understanding these potential impacts is crucial for healthcare providers in offering comprehensive care that addresses both the physical and emotional aspects of living with epidermoid cysts.

Epidermoid Cysts vs. Other Skin Conditions: Differential Diagnosis

Epidermoid cysts can sometimes be mistaken for other skin conditions. How can you differentiate between an epidermoid cyst and other similar skin issues?

Common Conditions Mistaken for Epidermoid Cysts

1. Sebaceous Cysts: These are similar but originate from sebaceous glands rather than epidermal cells.
2. Lipomas: These are benign fatty tumors that feel softer and more rubbery than epidermoid cysts.
3. Boils: These are painful, pus-filled bumps caused by bacterial infections.
4. Acne Cysts: These are deep, painful cysts that form as part of severe acne.

Accurate diagnosis is crucial for proper treatment. If you’re unsure about a skin growth, it’s always best to consult a dermatologist for a professional evaluation.

The Role of Genetics in Epidermoid Cyst Formation

While many epidermoid cysts occur sporadically, there’s evidence to suggest that genetics may play a role in their development. But how significant is this genetic component?

Genetic Factors in Epidermoid Cyst Development

• Some genetic syndromes, such as Gardner syndrome, are associated with an increased risk of multiple epidermoid cysts
• Certain gene mutations may predispose individuals to cyst formation
• Family history can sometimes indicate a higher likelihood of developing epidermoid cysts

While genetics can influence susceptibility, it’s important to note that environmental factors and skin care habits also play significant roles in cyst formation.

Epidermoid Cysts in Special Populations

While epidermoid cysts can affect anyone, certain populations may have unique considerations when it comes to these skin growths. How do epidermoid cysts manifest in different groups?

Epidermoid Cysts in Various Demographics

• Children: Less common but can occur, often requiring more careful management
• Elderly: May have a higher risk due to cumulative sun damage and skin changes
• Pregnant Women: Hormonal changes can sometimes influence cyst growth or appearance
• People with Compromised Immune Systems: May be at higher risk for cyst infection

Understanding these differences is crucial for healthcare providers in tailoring treatment approaches to individual patient needs.

The Future of Epidermoid Cyst Treatment: Emerging Therapies

As medical research advances, new treatments for epidermoid cysts are being explored. What cutting-edge therapies might we see in the future for managing these skin growths?

Promising New Treatment Approaches

1. Immunotherapy: Targeting the immune response to prevent cyst formation
2. Gene Therapy: Addressing genetic factors that contribute to cyst development
3. Advanced Laser Techniques: More precise and less invasive removal methods
4. Topical Treatments: New formulations to dissolve cysts without surgery

While these treatments are still in various stages of research and development, they offer hope for more effective and less invasive management of epidermoid cysts in the future.

Living with Epidermoid Cysts: Coping Strategies and Support

For individuals dealing with recurrent or persistent epidermoid cysts, developing effective coping strategies is crucial. What approaches can help in managing the physical and emotional aspects of living with these skin growths?

Practical Coping Techniques

• Educate yourself about the condition to reduce anxiety and uncertainty
• Join support groups or online communities to connect with others experiencing similar issues
• Practice stress-reduction techniques, as stress can sometimes exacerbate skin conditions
• Work with a dermatologist to develop a long-term management plan
• Consider counseling if the cysts are causing significant emotional distress

Remember, while epidermoid cysts can be frustrating, they are manageable with the right approach and support system.

Epidermoid Cysts in Popular Culture and Misconceptions

Epidermoid cysts have found their way into popular culture, often leading to misconceptions about their nature and treatment. How are these cysts portrayed in media, and what common myths need debunking?

Common Misconceptions About Epidermoid Cysts

1. Myth: All lumps under the skin are cysts. Reality: Many different types of growths can occur under the skin, and proper diagnosis is crucial.
2. Myth: Popping a cyst at home is an effective treatment. Reality: This can lead to infection and scarring, and should be avoided.
3. Myth: Epidermoid cysts are contagious. Reality: These cysts are not infectious and cannot spread from person to person.
4. Myth: Cysts always require surgical removal. Reality: Many cysts resolve on their own or can be managed with less invasive treatments.

Educating the public about the realities of epidermoid cysts is crucial for promoting proper care and reducing unnecessary anxiety about these common skin growths.

The Economic Impact of Epidermoid Cysts

While often considered a minor medical issue, epidermoid cysts can have significant economic implications, both for individuals and healthcare systems. What are the financial aspects of diagnosing and treating these skin growths?

Financial Considerations of Epidermoid Cyst Management

• Cost of dermatologist consultations and diagnostic procedures
• Expenses related to surgical removal or other treatments
• Potential lost work time due to treatment or complications
• Long-term costs of managing recurrent cysts
• Impact on health insurance premiums and coverage

Understanding these economic factors can help individuals and healthcare providers make informed decisions about treatment options and management strategies.

Epidermoid Cysts and Skin Cancer: Understanding the Relationship

While epidermoid cysts are typically benign, there’s often concern about their potential relationship to skin cancer. How are these conditions related, and what should individuals be aware of?

Key Points About Epidermoid Cysts and Skin Cancer

• Epidermoid cysts are generally not precursors to skin cancer
• In rare cases, long-standing cysts may develop malignant changes
• Any rapid changes in size, color, or texture of a cyst should be evaluated by a healthcare professional
• Regular skin checks can help identify any concerning changes early

While the risk of an epidermoid cyst becoming cancerous is very low, maintaining awareness and seeking prompt medical attention for any unusual changes is always advisable.

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

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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.