Steatocystoma multiplex associated with rheumatoid arthritis – a case report

Abstract

Steatocystoma multiplex (MS) is a benign skin condition characterized by the formation of cysts in the sebaceous glands. It is an autosomal dominant condition associated with keratin 17 gene mutation, but sporadic cases are also reported, which confirms the multifactorial etiology of the disease. Adults and adolescents are more often affected, rarely children and the elderly. Compared to women, men suffer from MS more often. Cystic formations tend to appear in areas where the pilosebaceous glands are well-developed. The most common locations are on the neck, chest, axilla and chest, less often on the face. The specialized literature reports the association of MS with keratoacanthoma, hidradenitis suppurativa, ichthyosis, but also rheumatoid arthritis. The diagnosis is mostly clinical, and the histopathological examination, being a pathognomonic one, is useful in confirming the diagnosis when the clinical examination is uncertain. Several treatment options are reported including surgical excision, laser, and aromatic retinoids, but long-term management remains a therapeutic challenge. Case study presents the clinical manifestations and management of a specific clinical case. We present the case of patient B.I, 48 years old, assisted in the dermatology department for disseminated skin lesions on the face, chest and back accompanied by moderate pain with a 5-year onset. From the anamnesis, other family members didn’t have similar lesions. From the comorbidities, rheumatoid arthritis with rapidly progressive evolution, high activity, complicated with myopathy, polyosteoarthritis and osteoporosis was determined. For the disease, the patient administered Methylprednisolone, Hydroxychloroquine, systemic Leflunomide and intraocular Taurine. Clinically were revealed nodular lesions of different sizes with a smooth pinkish-yellow surface, in some places cystic lesions. Paraclinically, were attested elevated values of the rheumatoid factor and leukocytosis. Histopathological examination confirmed cysts located in the dermis with diffuse peripheral fibrous proliferation. Taking into account the concomitant disease for which retinoids are contraindicated, the therapeutic option was surgical excision, which led to a favorable evolution of the skin process, the patient being redirected for alternative laser procedures. Discussions MS is a dermatological condition with aesthetic and psychological impact, especially the forms with facial localization. Conventional excision techniques, as well as retinoids, are effective in the presence of multiple lesions. The combination of alternative treatment methods such as laser minimizes the risk of recurrences and scars, thus increasing the effectiveness of the treatment and the aesthetic appearance of the patient. Conclusion The particularity of the case is the presence of a sporadic steatocystoma multiplex with facial involvement in a patient with severe rheumatological comorbidity. The management of multiple lesions was achieved by associeting surgical and laser methods.