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myxoid cyst (mucous cyst, digital myxoid pseudocyst)
Digital myxoid pseudocyst.
Etiology:
1) unknown
2) often associated with Heberden's node in patients with osteoarthritis
3) less commonly associated with chronic irritation, ill-fitting shoes [3]
Epidemiology:
- generally occurs in the elderly (> 60 years of age)
Pathology:
- cyst associated with extension of joint's synovial lining
- pseudocyst resulting from the leakage of join mucin into the surrounding skin
Clinical manifestations:
1) generally solitary cyst
2) rubbery & translucent in character
3) occurs on dorsal aspect of distal interphalangeal joint on finger, less commonly on toe
4) occurs at the base of a fingernail or toenail
5) cystic appearance & transillumination
6) clear gelatinous fluid may be exuded from opening
7) when a myxoid cyst is over the nail matrix, nail plate dystrophy occurs
Management:
- firm compression daily over a period of weeks [1]
- due oto the possiblity of communication with the joint space, excision, cryotherapy or intralesional glucorticoid should be performed only by physicians experienced in treating these lesions [2]
General
synovial cyst
pseudocyst
References
- Color Atlas & Synopsis of Clinical Dermatology, Common
& Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY,
1997, pg 164-65
- Medical Knowledge Self Assessment Program (MKSAP) 15,
American College of Physicians, Philadelphia 2009
- NEJM Knowledge+ Dermatology
- Salerni G, Alonzo C
Images in Clinical Medicine: Digital Mucous Cyst
N Engl J Med. 2012 Apr 5;366(14):1335.
PMID: 22475597 Free article.
https://www.nejm.org/doi/pdf/10.1056/NEJMicm1111833