Atheroma - Causes, symptoms and treatment. MF.

An atheroma - a cyst located in the skin of the sebaceous gland, arising from the difficulty or complete cessation of the outflow of a secret from it due to occlusion of the external opening of its excretory duct. The secret, accumulating in the duct of the gland, stretches it, forming a gradually increasing cavity with sebaceous contents including detritus( dead organic matter), keratinized epidermal cells, fat droplets and cholesterol crystals. From the inside, the atheroma is expelled by a flat epithelium.

Schematic structure of atheroma: 1 - cavity atheroma with sebaceous contents including detritus( dead organic matter), keratinized epidermal cells, fat droplets and cholesterol crystals;2 - capsule of atheroma;3 - aperture of the blocked and expanded duct of the sebaceous gland( it does not always happen);4 - leather;5 - subcutaneous fatty tissue.

Atheroma is the most common surgical disease of the appendages of the skin, it is equally common in both male and female faces.

Identify a true atheroma that develops from epidermal cells that are ligated during embryonic development and is a hereditary condition, and a false atheroma resulting from occlusion of the duct of the sebaceous gland, which causes accumulation of the gland in the lumen of the gland and the gradual formation of a sac filled with atheromatous masses( alteredsebum).

Causes of Atheroma

The cause of atheroma may be metabolic disorders, leading to a change in the nature of secretion( segregation) of sebaceous glands, which causes plugging of their ducts. Atheroma often appears with excessive sweating, which is especially pronounced in the case of the hormonal changes that occur in oily seborrhoea and acne and create an unfavorable background for the development of cysts of the glands. To predisposing to the development of athe factors, it is customary to refer to unfavorable environmental conditions and chronic traumatism of the skin.

Symptoms of atheroma

Atheromas can be located on body parts rich in sebaceous glands, which include the scalp, face( especially below the mouth line), the posterior surface of the neck, the interscapular space, the coccyx and genital area.
Atheroma has the appearance of a soft subcutaneous formation of a rounded shape, with clear boundaries and various sizes( from the size of a pea to a chicken egg and even more).Atheroma is covered with normal skin, being fixed in it. When examining an atheroma in its center, a blocked and dilated duct of the sebaceous gland can be detected, through which atheromatous masses can be released in some cases. At palpation, atheroma, as a rule, is painless and mobile: it moves together with the skin with respect to deeper tissues.

Appearance of atheroma

Atheroma can remain small for many years or increase in size. The atheroma grows slowly, but when reaching a large size( up to 4-5 cm) can cause a cosmetic defect.

Originally emerged as a small globular form, atheroma can later be opened and transformed into an ulcer. In some cases, it can be stuffed with a dense connective tissue capsule and remain in the form of a fairly dense, painless, globular tumor.

Complications of atheroma

Quite often, especially with prolonged existence of atheroma, their suppuration occurs. In this case, a subcutaneous abscess is formed. The pronounced inflammatory process with suppuration of atheroma leads to pain in the area of ​​tumor, hyperemia( reddening) and puffiness of the skin, as well as worsening the general condition of the patient, increasing body temperature. Sometimes there is a spontaneous dissection of festering atheroma, while pus from it, which has an unpleasant smell, is released.
Very rarely, atheroma is able to degenerate into a malignant tumor.

Survey and laboratory diagnosis of atheroma

For the final diagnosis of the disease, it is necessary to obtain the results of a histological examination that allows in different cases differentiate atheroma from fibroma, lipoma and hygroma.

Treatment of atheroma

The primary method of treating atheros is a surgical operation, consisting in the removal of this cyst under local anesthesia. The indication for excising atheroma is its large size, as well as the patient's desire to achieve a cosmetic effect. Surgical intervention can be performed in a clinic, but with significant dimensions of atheroma and complicated localization, it is recommended that the patient be hospitalized. Atheroma is excised together with the capsule, which is the key to successful treatment. In uncomplicated atheroma, the following surgical options are possible:

1 .A cutaneous incision is made above the place where the atheroma most protrudes. The contents of the atheroma are squeezed outward, collected by a napkin. Then the capsule of the cyst is taken up by clamps and removed. Sometimes resort to scraping the cavity of the cyst with a special surgical instrument - a sharp spoon.

2 .After dissecting the skin over the atheroma so as not to damage its capsule, the skin from the atheroma is shifted, then, by pressing the fingers on the edges of the wound, the atheroma is harvested.

3 .The most common method of surgical treatment at present is the following.

Initially, above the atheroma, two fringing incisions are made, covering the opening of the cyst. The edges of the skin incision are seized by surgical clamps. Simultaneously with a careful stretching for the clamps, under the atheroma branches of curved scissors are used, with the help of which the atheroma is extracted from the surrounding tissues. After hatching atheroma, separate seams are applied to the subcutaneous tissue with absorbable fiber, and vertical mattress sutures are applied to the skin using a thin atraumatic thread, which are removed after 7 days.

Schematic depiction of surgical intervention for the removal of atheroma( option 3): 1 - atheroma in the capsule;2 - a patch of skin excised by the fringing incision above the atheroma;3 - healthy skin;4 - subcutaneous fatty tissue;5 - surgical clamps that hold the edges of the removed area of ​​the skin;6 - scissors.

Suppuration of atheroma is an absolute indication for surgical intervention. In this case, often only used to open it to ensure the outflow of purulent contents.

Currently, in connection with a good cosmetic effect, laser excision is used even festering atheroids under local infiltration anesthesia, which can be done using one of three techniques:

1. Laser photocoagulation : is the complete evaporation of the pathological focus within healthy tissues. It is used in those cases when the diameter of the atheroma during the period of suppuration does not exceed 0.5 cm. Sealing after laser photocoagulation is not required, the healing takes place under a coagulation crust, which lasts from 7 to 15 days, depending on the size of the wound.

2. Laser excision of atheromas with is used with a diameter of festering atheroma from 0.5 cm to 2.0 cm and reduces to the following: a skin with a spindle-shaped incision cuts the skin above the atheroma, and the soldered section is necessarily excised;the skin flap is taken on the holder, after which the sheath of the atheroma gradually emerges with the help of a laser beam;Primed seams are superimposed on the wound, rubber drainage is left. Seams after laser excision are removed on the 8th -12th day after the operation.

3. Laser evaporation of the atheroma shell from within is used in cases where the diameter of suppurated atheroma is more than 2.0 cm. The procedure is as follows: The atheroma is opened by a scalpel with a small spindle-shaped incision, a jointed area is necessarily excised. The purulent contents of the atheroma are removed by dry tampons of gauze. After this, the edges of the operating wound are diluted with sharp hooks, with the help of a laser beam, the atheroma membrane evaporates from the inside. The wound is superimposed with primary seams, leaving a rubber drainage. Seams after laser evaporation of the atheroma shell from the inside are removed on the 8th -12th day after the operation.

Prevention of atheroma

To prevent the onset of atheroth, it is recommended to wash your face with hot soapy water, while intensively rubbing your skin with a hygienic sponge or washcloth, hold steam baths, and also cleanse your face and plastic massage.

It is important to exclude food containing a large number of animal fats and carbohydrates.

Doctor surgeon Kletkin ME