Table 1.

Summary of available publications describing treatment outcomes for SM, by treatment

REFERENCENO. OF PARTICIPANTSSM OR SMSLOCATION OF CYSTSTREATMENT DESCRIPTIONBENEFITSLIMITATIONS
Laser
Kassira et al, 2016111SMFaceFractionated ablative CO2 laser
  • Led to spontaneous expression of cystic content

  • No recurrence at 3 y

  • Less time-consuming procedure

  • Minimal risk of scarring

  • Treated cysts were small and localized to the temple

Bakkour and Madan, 2014128SMChest, back, and axillaCO2 laser incision and cyst removal with Volkmann spoon
  • Good clinical improvement

  • Minimally invasive, allowing for multiple treatments in 1 session

  • Minimal scarring and little recurrence

Moody et al, 2012131SMAbdomen and lower chestTargeted laser treatment of the sebaceous glands and dermal cysts
  • Good improvement (75% reduction)

  • Noninvasive

  • Allows for treatment of multiple lesions

  • None reported

Varshney et al, 2011141SMHead and neckCO2 laser ablation
  • Good cosmetic results

  • No recurrence at 18 mo

  • None reported

Mumcuoğlu et al, 2010151SMChest, forehead, axillae, and kneesEr:YAG laser and drainage
  • Good cosmetic results with no scarring

  • No recurrence at 3 mo

  • None reported

Madan and August, 2009161SMBack, chest, and abdomenCO2 laser incision and cyst removal with Volkmann spoon
  • Minimally invasive

  • Postinflammatory hyperpigmentation

Riedel et al,* 2008171SMForehead and cheeksLaser and surgical: incision, cyst removal with sharp spoon, followed by CO2 vaporization of remaining content
  • No recurrence at 8 mo

  • Good clinical improvement

  • None reported

Rossi et al, 2003181SMForehead, eyelids, and neckCO2 laser and cyst removal with forceps
  • Minimally invasive with quick healing

  • Good cosmetic results with no recurrence at 2 y

  • Can treat multiple lesions without anesthesia

  • None reported

Krähenbühl et al, 1991191SMTrunkFocused CO2 laser incision followed by defocused laser therapy of cyst wall
  • Good clinical improvement

  • Quick healing

  • Scar formation

Surgical
Kumar et al, 2014201SMMalar regionWide local surgical excision
  • Total excision and no recurrence

  • Scar formation

  • Requires anesthesia

  • Limited to treating localized regions

Gordon Spratt et al,* 2013211SMSThigh, buttocks, groin, arms, and legsSurgical and antimicrobial therapy: incision and drainage followed by topical clindamycin solution and benzoyl peroxide wash
  • Can treat grossly enlarged and infected nodules

  • None reported

Choudhary et al, 201042SMScrotumIncision using a radiofrequency instrument, drainage, and cyst extraction with forceps
  • Complete removal and no recurrence at 5.5 mo

  • No scarring or postinflammatory hyperpigmentation

  • Provides a bloodless field

  • Able to treat multiple cysts in 1 sitting

  • None reported

Lee et al, 2007225SMNot reportedIncision and vein hook cyst removal
  • Complete removal and no recurrence at 14–30 mo

  • Faster than other surgical techniques (1 min/cyst)

  • Mild transient hyperpigmentation: resulted in satisfactory cosmetic outcome

Ichikawa et al, 2006231SMFaceForehead flap and cyst extraction
  • Complete removal

  • Scar formation hidden by hairline

  • Recurrence 16 mo postoperatively

  • Invasive and surgical risks

Düzova and Șentürk, 2004242SMFace22-gauge needle aspiration
  • Very good cosmetic outcome

  • No recurrence at 10 mo

  • Challenging to extirpate the dense contents of larger cysts

  • Risk of hematoma

Kaya et al, 2001251SMChest, neck, axilla, inguinal folds, and inguinal regionsPuncture with sharp-tipped cautery point, drainage, and cyst removal with forceps
  • Good clinical improvement

  • No recurrence at 14 mo

  • Hypopigmented macules and superficial depressions

  • Requires multiple sessions

Schmook et al, 2001265SMNot reportedIncision, drainage, and cyst wall removal with curette followed by forceps
  • Virtually unnoticeable scarring

  • No recurrence at incision site

  • None reported

Adams et al, 1999271SMChest and neckIncision and cyst removal with small artery forceps
  • No visible scarring

  • No recurrence at 4 mo

  • Requires multiple sessions

Oertel and Scott, 199853SMArm, forearm, chest, neck, axilla, and breast22-gauge needle aspiration
  • No scar formation

  • Minimally invasive

  • Inexpensive procedure

  • Tedious, requiring precision and a skilled technique

Pamoukian and Westreich, 1997287SMHead and neckIncision and cyst removal with mosquito hemostat
  • Good clinical improvement

  • Recurrence of 10% of lesions

  • Time-consuming

  • Requires anesthesia

Kanekura et al, 1995291SMScalp, forehead, and chest3-mm biopsy punch, drainage, and cyst removal with forceps
  • Complete removal

  • Wounds healed in 10 d

  • No recurrence at 1 y

  • Time-consuming and not feasible to remove all lesions in 1 sitting (only 2 removed)

Sato et al, 1993301SMHead, neck, trunk, and upper extremitiesAspiration and scraping with a syringe connected to an 18-gauge needle
  • Reduction in number and size of cysts

  • Much improvement in psychological condition

  • Aspiration does not work on smaller cysts

Keefe et al, 1992311SMNeck, forearms, behind the ears, over the scapula, chestSurgical blade puncture, drainage, and cyst removal with forceps
  • Good clinical improvement

  • Minimal recurrence

  • Time-consuming, requiring multiple surgeons

  • Requires anesthesia

  • Scar formation

Feinstein et al, 1983321SMScalp and foreheadExcision and skin graft
  • No recurrence at 15 y

  • Inadequate cosmetic outcome

Holmes and Black, 1980331SMFace, trunk, and axillaeHairline flap and cyst extraction
  • No recurrence at 4 y

  • Incompleteclearance

  • Invasive and surgical risks

Egbert et al, 1979341SMS and SMEntire body surfaceIncision, drainage, and electrocautery
  • None reported

  • Required anesthesia and multiple visits to the operating room

Medical management
Lima Santana et al, 2016351SMSAxillary regions, inguinal region, trunk, lower limbs, antecubital fossae, face, and scalpIsotretinoin
  • Stabilized condition with no new or worsening lesions at 3 mo

  • Had minimal effect in decreasing the size or number of lesions

Adams and Shwayder, 2008361SMSFace, scalp, trunk, and extremitiesTetracycline
  • Cleared infected lesions on legs

  • Noninfected lesions persisted

Moritz and Silverman, 1988371NANot reportedIsotretinoin
  • Shrinkage of lesions that persisted at 6 mo

  • Delayed response: 2 mo after discontinuing

Friedman, 1987381SMNot reportedIsotretinoin
  • None reported

  • Provided no improvement

Rosen and Brodkin, 1986391SMSNot reportedIsotretinoin
  • Inflamed cysts markedly improved

  • Recurrence of cysts 8 wk into therapy

Statham and Cunliffe, 1984403SMS and SMTrunk and limbsIsotretinoin
  • Substantial improvement in inflamed lesions

  • No effect on noninflamed lesions

Schwartz and Goldsmith, 1984411SMSNot reportedIsotretinoin
  • Abscesses involuted and inflamed cysts decreased in size

  • Persisted at 10 wk after discontinuing therapy

  • Cysts returned after discontinuing treatment

Other
Kamra et al,*201331SMChest, breast, axilla, inguinal region, and extremitiesRadiofrequency probe and isotretinoin
  • None reported (suggested to provide a bloodless field)

  • None reported

Fekete and Fekete,* 2010421SMS and SMEntire body surfaceCryotherapy and isotretinoin
  • Slight regression and healing of lesions

  • Local disfigurement, hyperpigmentation, and unpleasant scars

Apaydin et al,* 200091SMS and SMEntire body surfaceCryotherapy and isotretinoin
  • Isotretinoin cleared inflamed lesions, which did not reappear

  • Cryotherapy caused scarring and hypopigmentation

Notowicz, 198043NASMNot reportedCryotherapy: necrotic tissue and cyst content removed with pressure 3–4 d later
  • Treatment of numerous lesions in 1 sitting

  • Extensive scar formation

  • CO2—carbon dioxide, Er:YAG—erbium:yttrium-aluminum-garnet, NA—not available, SM—steatocystoma multiplex, SMS–steatocystoma multiplex suppurativa.

  • * Combination therapy.