Info

Multiple sebaceous cysts over the scrotum is a rare condition and requires excision if infected or cosmetically unacceptable. Grossly enlarged or infected cysts require total excision of the scrotal wall followed by the coverage of bare testes. We are reporting a case of infected multiple sebaceous cysts on the scrotum. Total excision of scrotal wall followed by the fascio cutaneous flap coverage was done in this case.

A sebaceous cyst is a small, dome-shaped cyst that develops in the skin, filled with a thick, greasy, cheese like substance. Sebaceous cysts are very common and can occur in any area of hair-bearing skin, but mostly on the scalp. They are also found on the face, neck, back and scrotum. The cyst is looks like a hemisphere on the skin. It is whitish or skin-colored. Cysts usually vary in size from 1cm to 4cm in diameter. They occur singly or in groups. The cysts are usually painless but may become red and painful if infected. Etiology is unclear but duct obstruction of a sebaceous gland in the hair follicle can result into accumulation of the sebum leading to development of retention cyst. Other causes include a developmental defect of the sebaceous duct or traumatic implantation of surface epithelium beneath the skin. They can develop at any age but are usually first noticed in adult life.

Multiple sebaceous cysts over the scrotum are a rare condition and men use to ignore the lesions, as the condition is painless. But the cyst being in proximity with potentially infective area may catch infection from genitourinary tract. Cyst becomes painful if becomes infected and may burst to discharge pus. Single infected cyst can be drained without complications. Untreated it may spread in surrounding cysts and finally scrotal wall as seen in our patient. Once the scrotal skin is infected the infected portion has to be widely excised to avoid necrotizing fascitis of the scrotum (Fournier’s gangrene) and septicemia.

Coverage of the bare testes after the debridement of infected skin is done once the local infection is taken care of which usually takes 1-2 weeks. If the defect in scrotal wall is small secondary suturing with little mobilization of the scrotal wall can close it. Larger defects can be covered with split thickness skin grafting but the normal feel of moving of testes inside the scrotum cannot be achieved as graft lies directly on the bare testes. In case of total excision of the scrotal wall testes can be placed in the thigh pouch created on the medial side of the thigh. Testes are protected from the trauma by this method but it is cosmetically unacceptable for patient.

Cannistra C et al used the technique of pedicle inguinal flap for the reconstruction of the scrotum in cases of Fournier gangrene and allow cover of the scrotal region with relatively thick, sensitive tissue with limited scarring and functional sequel. We used fascio cutaneous flap from anterior aspect of both the thighs and sutured them in the midline over the bare testes. The triangular raw areas developed due to elevation and rotation of the flap should not be tried to close under tension which not only compromise the viability of the flap but also hamper the ballooning effect of the neo-scrotum by stretching and flattening it. The reconstruction as described above is technically demanding but the thick fasciocutaneous flap is protective for testes from trauma as well as balloon like appearance of neo-scrotum is cosmetically acceptable. Kochakarn W et al published a series of 12 cases proposed implantation of the exposed testes in the upper thigh pouch and delayed reconstruction of the scrotum using thigh pedicle flaps with excellent results. Monteiro et al describes about the technique of covering testes in Fournier’s gangrene with inner thigh flap. Infection is the most common complication followed by the flap necrosis. Flap necrosis can be avoided by designing broad based flaps.

Multiple sebaceous cysts over the scrotum is a rare condition but should be promptly treated if infected to avoid fatal sequels such as Fournier’s gangrene. Pedicle inguinal flap technique for the coverage of bare testes provides better cosmetic results than skin grafting and inner thigh pouch implantation of testes.

buy tetracycline antibiotics free prescription pills
FedEx overnight shipping free prescription online pharmacy

Many common growths develop on people’s skin. While the cause is often poorly understood, it is known that some are associated with aging, and others are inherited. Benign (non-cancerous) lesions are not life threatening, but people often have these lesions removed for cosmetic reasons. A lesion may be removed for medical reasons if cancer is suspected. When a lesion bleeds or causes pain, inflammation, or irritation, it also is typically removed.

Epidermoid and Pilar Cysts (Sebaceous Cysts)

A cyst is a benign growth that forms when an inner lining or sac fills with a cheesy material. Epidermoid cysts have a central opening from which a rancid material can be expressed. If they are located in the upper layers of the skin, they may have a yellow or white appearance and have prominent overlying blood vessels. Epidermoid cysts most commonly occur on the face, neck, and back. Pilar cysts are primarily located on the scalp. Inheritance may play a role in patients with multiple lesions. Epidermoid cysts may arise following surgery or injury to the skin. If a cyst enlarges rapidly and ruptures, a boil-like lesion results that usually requires treatment with an antibiotic and surgical removal of the sac. It is easier to remove the cyst when it is not inflamed. This may prevent the possibility of infection. If a cyst begins to enlarge rapidly, becomes inflamed, breaks down, or becomes painful, it should be examined by a dermatologist immediately.

Sebaceous Gland Hyperplasia

Appearing as small white or yellow lesions, sebaceous gland hyperplasia occurs on the faces of people with oily skin. The lesions may have prominent tiny blood vessels and can resemble basal cell carcinoma, a type of skin cancer; therefore, a skin biopsy may be performed. Treatment of sebaceous gland hyperplasia includes electrosurgery, cryosurgery (freezing), laser surgery, and photodynamic therapy (photoactive chemicals and a light source).

Sebaceous Glands

Exocrine glands of the skin, many of which open into the hair follicles and secrete an oily substance that coats the hair and surrounding epithelium, helping to prevent evaporation of sweat and retain body heat. In the oral cavity, these glands are known as Fordyce’s granules or Fordyce’s spots and can be seen with the unaided eye as yellowish-white in color and are more common in older adults on the buccal and labial mucosa.

Xanthelasma

These lesions develop on the eyelids and are yellowish or whitish in color due to lipid (fat) deposits in the skin. They may occur in individuals with normal lipid levels, or they can be associated with a lipid-metabolism disorder, especially high cholesterol levels. People with xanthelasma should be evaluated for elevated or abnormal cholesterol and triglycerides. Treatment options include surgery, electrosurgery, cryosurgery, laser surgery, and the application of acids.

Syringoma

Syringomas are small (2 millimeter) lesions of sweat gland ducts. They occur most often in women, form frequently on the lower eyelid, and are usually skin colored. The lesions also may be white. They are asymptomatic (do not hurt or itch). Treatment includes electrosurgery, surgical removal, laser surgery, and dermabrasion.

Trichoepithelioma

Trichoepitheliomas are small skin-colored lesions that occur most commonly on the face and neck and may resemble basal cell carcinoma, a type of skin cancer. The cause is not completely understood. These tumors represent the body’s attempt to form hair follicles and shafts. In some people, they can become quite numerous and large, and interfere with everyday function if they occur in areas such as the ear canal or eye region. These can be removed with surgery, laser treatment, or dermabrasion.

Seborrheic Keratoses and Verrucous Acanthoma

These lesions have a wart-like appearance, and may be smooth or flat. They can range in color from skin-colored to jet black. If they have a mixture of brown and black colors, they can resemble an atypical mole or melanoma, a lethal form of skin cancer, and a biopsy may be performed. In general, seborrheic keratoses are quite common and numerous. If one is extremely large and thick, it is known as a verrucous acanthoma. Most frequently seen in older individuals, seborrheic keratoses may be inherited. In people with skin of color, they often appear as small black lesions around the eyes (dermatosis papulosa nigra). Lesions may be removed for cosmetic reasons or if they are associated with intense itching, irritation, or bleeding. Treatment includes cryosurgery (freezing), shaving, curettage (scraping), and electrodessication (burning).

buy tetracycline antibiotics free prescription pills
FedEx overnight shipping free prescription online pharmacy