Epidermal cyst (atheroma)
What is the disease? It gradually grows larger as waste products accumulate in the subcutaneous tissue adjacent to the skin. It is a disease that causes lumps, but the nature of the disease differs from tumors (neoplasms) that occur as a result of abnormal cell proliferation, in that the contents are poor in cellular components and filled with a thick, foul-smelling muddy substance. It can occur anywhere on the body, but is said to be most common on the back and face. What is the cause?It is thought to occur when waste products from the skin accumulate in a pouch-like tissue that is formed right next to the skin for some reason. It is said to be triggered by repeated irritation to the skin or when part of the skin moves inward due to trauma. How symptoms manifestThe appearance of a lump is the first sign of a cyst. Most are a few centimeters in size, but in rare cases they can grow to over 10 cm (Figure 56). If you closely observe the condition of the skin around the lump, you may find a small hole where the lump is closest to the skin. If you try to forcefully pop a bump, a thick, foul-smelling substance may come out. It is not usually painful, but it can become infected, causing redness, swelling, and pain. Although very rare, this disease can sometimes lead to skin cancer, so you should be careful if something that has remained the same size for a long time suddenly grows larger. Testing and diagnosisTypically, the diagnosis can be suspected just by examining the patient in an outpatient setting. If the tumor is too large and differentiation from other tumors is required, or if surgery is required, imaging diagnostics such as MRI may be required. Treatment methodsIf the lesion is relatively small and does not cause any pain or other symptoms, it is usually sufficient to simply observe the condition. If bacteria have caused the lesion to become red and swollen, the infection may be calmed down by administering antibiotics, but if the lesion has progressed, surgery is recommended. Other cases where surgery is required include when examining tissue under a microscope to differentiate it from other tumors, when there is an unpleasant odor, when it is noticeable from the outside, etc. Usually, it is a day surgery under local anesthesia, but in large cases, hospitalization may be required for treatment. What to do if you notice an illnessIf you find a lump that you think may be a sebaceous cyst, first consult your local orthopedic or dermatologist. If it is red, swollen, and infected with bacteria, early treatment is required. If it is too large and needs to be differentiated from other tumors, it is a good idea to consult a doctor at a specialized facility. Kenji Morii "> Figure 56 Atheroma Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia |
どんな病気か 皮膚に隣接した皮下組織に老廃物がたまって徐々に大きくなってくる 瘤ができる病気ですが、異常な細胞増殖の結果、発生する腫瘍（新生物）とは病気の性質が異なり、中身は細胞成分に乏しく、ドロドロした悪臭を伴う泥状の物質で満たされています。体のどこにでも発生しますが、背中や顔などに多いといわれています。 原因は何か皮膚の老廃物が、何らかの原因でできた皮膚のすぐそばの袋状の組織に蓄積されることで起こると考えられています。皮膚への反復した刺激や、皮膚の一部が外傷などで内側に入り込むことなどが契機となるといわれています。 症状の現れ方瘤が発生することで自覚されます。多くは数㎝大ですが、まれに10㎝以上の大きさをとるものがあります（図56）。瘤のまわりの皮膚の状態をよく観察すると、瘤が皮膚に最も接している部分には小さな穴が見つかることがあります。 瘤を無理に潰そうとすると、ドロドロした悪臭を放つ物質が出てくることがあります。普通は痛みを伴うことはありませんが、細菌が感染することがあり、その場合は赤くはれ上がって痛みます。 ごくまれですが、この病気から皮膚がんが発生することがあり、今まで長い間同じ大きさで経過していたものが急に大きくなったときなどに注意が必要です。 検査と診断典型的なものは、患者さんを外来で診察しただけでこの病気を疑うことができます。あまりに大きく、ほかの腫瘍性疾患などとの鑑別が必要な場合や、手術を行う場合などはMRIなどの画像診断を行うことがあります。 治療の方法比較的小さく痛みなどの症状がない場合は、多くは経過観察のみでよいでしょう。細菌がついて赤くはれてきた場合は、抗生物質の投与で感染した状態を鎮静できる可能性がありますが、進行したものは手術を行うほうがよいでしょう。 その他、手術が必要となるのは、ほかの腫瘍性疾患との鑑別のため顕微鏡で組織を調べる場合、不快なにおいが気になる場合、外見上目立つなど審美的に気になる場合などです。通常、局所麻酔での日帰り手術となりますが、サイズが大きな症例などは入院して治療する場合もあります。 病気に気づいたらどうする粉瘤と思われる瘤が現れた場合は、まず近所の整形外科や皮膚科に相談しましょう。赤くはれ上がって細菌が感染した状態の場合は早期の対応が必要です。あまりにサイズが大きいなどほかの腫瘍との鑑別が必要な場合は、専門施設の医師に相談するとよいでしょう。 森井 健司 "> 図56 粉瘤 出典 法研「六訂版 家庭医学大全科」六訂版 家庭医学大全科について 情報 |
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