Atheroma on the head

In terms of localization, atheroma is most often found on the head, which is due to its morphological features - prevalence and connection of the sebaceous glands with the scalp (hair follicles).

Atheroma is a benign sebaceous gland cyst that forms for various reasons and is diagnosed in patients of any age and gender. The neoplasm has a typical cyst structure - a capsule and specific contents, detritus. Detritus in turn includes cholesterol crystals, epithelial cells, fat, keratinized particles.

[ 1 ], [ 2 ]

Causes of atheroma on the head

The etiology of atheromas has not yet been clarified. However, in medical practice, so-called "fatty tumors" are often encountered; among them, there may be benign tumors of varying structure and histology. Atheromas are divided into the following types:

1. Secondary sebaceous cysts caused by obstruction of the excretory duct. Such neoplasms are called retention, they usually form on those parts of the body where hair grows, mainly on the head.
2. Epidermoid congenital cysts, caused by a hereditary factor and having a denser structure of both the capsule and detritus.

The causes of atheroma on the head are associated with the peculiarities of the development of the cyst, it is formed in the ducts of the sebaceous glands, mainly near the hair bulb, follicle. In fact, this is an obturated excretory duct, blocked at the exit. Atheroma on the head can reach impressive sizes, up to 8-10 centimeters in diameter, since the scalp is densely saturated with glandulae sebaseae (alveolar glands) up to 900 per square centimeter. The mechanism of formation of a subcutaneous cyst is explained by various factors, but the most common cause is damage, inflammation, disease of the hair follicle, most often - seborrhea. As a result of the action of the provoking factor, the gland duct narrows and is not able to adequately remove sebum to the outside, to the skin. In the process of increasing atheroma, forming its capsule, the structure of the detritus begins to change, it becomes thicker, which ultimately leads to complete blockage of the excretory opening.

The most common causes of atheroma on the head:

• Damage to hair follicles due to seborrhea.
• Damage to the sebaceous gland due to inflammation of the scalp.
• Genetic predisposition to the formation of benign retention cysts.
• Metabolic disorder.
• Diabetes mellitus.
• Trauma to the sebaceous gland due to a wound, cut, or head injury.
• Gardner syndrome (a rare hereditary disease).
• Hormonal, endocrine disorders.
• Violation of hygiene rules and scalp care.
• Use of chemicals for hair care (hair dye, chemical styling products, perms, etc.).
• Hyperhidrosis (excessive sweating associated with hormonal dysfunction).
• Increased testosterone levels due to age-related, physiological changes in the body – puberty, age after 45-50 years (in men).

[ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ]

Symptoms of atheroma on the head

Clinically, atheroma manifests itself only when it becomes quite large; the early stage of its development, as a rule, is asymptomatic.

Symptoms of atheroma on the head are as follows: •

• A rounded lump on the scalp in any area.
• The surface of the atheroma is smooth, the skin does not change color or structure.
• The cyst is quite mobile upon palpation, but does not shift, and is partially fused with the skin in the area of its localization.
• Atheroma always has clearly defined contours.
• An atheroma on the head does not cause pain unless it is damaged or inflamed.
• The cyst can open spontaneously even without signs of inflammation, and the contents of the opening leak out in the form of a sebaceous secretion, white in color, of a mushy consistency.
• Atheroma is prone to inflammation, therefore it often suppurates with all the characteristic signs of a subcutaneous abscess.
• An inflamed atheroma manifests itself as pain at the site of localization.
• The skin at the site of the abscess formation is hyperemic and edematous.
• If the cyst is large, the purulent process develops quickly, and not only the local temperature of the skin but also the whole body increases.
• When an atheroma becomes purulent, it can open up on its own, with pus flowing out.
• A more serious condition is considered to be subcutaneous opening of an inflamed atheroma with signs of general intoxication of the body - headache, drop in blood pressure, sharp deterioration in health.

A simple retention cyst on the head is not considered a serious disease, however, a large, massive atheroma can not only cause psychological or cosmetic discomfort, but also compress nearby blood vessels, causing severe headaches.

Atheroma of the scalp

Atheroma (epithelial retention cyst) most often forms in those areas of the body where hair follicles are located. Atheroma of the scalp is the most common localization of such neoplasms, which are considered benign and never degenerate into a malignant process.

A scalp cyst is formed as a result of gradual, slow narrowing of the sebaceous gland duct. It should be noted that, according to trichologists, there are on average up to 100 thousand hairs growing on the head. Considering that, unlike sweat glands, glandulae sebaseae (sebaceous glands) are almost always connected to hair follicles, an atheroma on the scalp has all the conditions for its development. The causes of such cysts are different, they can be associated with metabolic disorders or hormonal dysfunctions, injuries to the scalp or seborrhea. In dermatology, the factors that provoke atheromas have been little studied, apparently due to the fact that such retention cysts are subject to removal in any case, during which tissue is collected for histological examination. In fact, histology determines the differential diagnosis and the nature of the so-called "wen" on the head.

In the clinical sense, atheroma on the scalp is either a single neoplasm of a dense structure and quite large size, or multiple small cysts - atheromatosis. Atheroma does not hurt if it is not inflamed, develops without obvious clinical signs, very slowly. Purulent atheromas are painful, prone to spontaneous opening, often recur.

Treatment of a subcutaneous sebaceous cyst on the head is determined by a doctor, but in 100% of cases it will only be surgical. Modern medical technologies allow removing atheroma within 25-40 minutes on an outpatient basis, almost painlessly. The only downside of the operation may be the need for partial removal (shaving) of hair, but, as a rule, this method is used only for enucleation of a large cyst, when it is not possible to use the radio wave method. Laser and radio wave removal of atheroma does not require such "sacrifices" on the part of the patient, but these methods can be effective only in the treatment of small cysts that do not have signs of inflammation. Therefore, at the first atypical symptoms, the appearance of small seals in the scalp, you should consult a doctor without waiting for the atheroma to grow or fester.

[ 8 ], [ 9 ], [ 10 ]

Atheroma on the back of the head

An atheroma that forms in the occipital area can be provoked not only by common causes - metabolic disorders, hormonal dysfunction, but also by purely domestic traumatic factors, for example, constant wearing of a tight headdress, or features of a woman's hairstyle (hairpins on the back of the head, chignons, etc.). As a result of constant mechanical impact on the skin of the back of the head, the function of the sebaceous glands changes, they narrow due to poor tissue nutrition, become clogged, creating all the conditions for the formation of internal capsules with sebaceous contents. Quite often, an atheroma on the back of the head develops due to increased sweating or poor hygiene of the scalp. The cause of the cyst is determined by a doctor, but it is more important to differentiate an atheroma from neoplasms that are similar in appearance.

Differential diagnostics of atheroma on the back of the head involves distinguishing it from the following soft tissue subcutaneous diseases:

• Hemangioma of the occipital part of the head.
• Herniation of the meninges (rare, as it has specific symptoms).
• Lipoma (true lipoma, benign tumor).
• Lymphadenitis of the lower part of the occiput.
• Dermoid cyst.

Treatment of sebaceous gland cysts involves their removal. No other method gives results, moreover, it can provoke an inflammatory process and suppuration of the atheroma. An inflamed cyst is more difficult to treat, since it is first opened, drained, and only after the clinical signs of the process subside, an operation is performed. Consequently, the procedure is accompanied by repeated incisions of the skin, which inevitably leads to the formation of scars. An atheroma on the back of the head can be removed at any stage, but its neutralization is more effective when the neoplasm is small (up to 3 centimeters) and has no signs of suppuration.

[ 11 ], [ 12 ], [ 13 ], [ 14 ], [ 15 ]

Diagnosis of atheroma on the head

It is almost impossible to diagnose a sebaceous gland cyst in the initial period of its development due to the fact that the neoplasm is formed asymptomatically. As a rule, the patient consults a doctor when the atheroma is already noticeable and visible.

Diagnosis of atheroma on the head is carried out according to the following algorithm:

• Primary visual examination of the scalp.
• Palpation, including nearby lymph nodes.
• Visual differentiation of atheroma from other neoplasms. The main criterion is the presence of a visible outlet, possibly obturated, opening of the sebaceous gland, which is not typical for lipoma or dermoid cyst.
• To clarify the nature of the neoplasm, Doppler ultrasonography, ultrasound of the cyst, CT scan or X-ray of the skull may be prescribed.
• Histological examination of atheroma tissue, the material is taken during surgery.

Diagnosis of atheroma on the head should be differential, the cyst should be separated from the following neoplasms:

• Lipoma (subcutaneous tumor) – lies deeper than atheroma.
• Fibroma is denser in structure and fused with the skin.
• Papilloma has specific visual criteria.
• Hemangioma is a neoplasm of blood vessels, without clear contours, loose formations determined by palpation.
• Dermoid is a congenital dense cyst.

The main differential criterion is histological examination, which determines with 100% accuracy atheroma or other benign neoplasms of the skin and subcutaneous tissue of the head.

Treatment of atheroma on the head

Atheroma is treated surgically. Any suggestion of a conservative or unconventional method should be considered incorrect and even dangerous. A sebaceous gland cyst cannot be resolved by definition, this is due to its morphology. The atheroma capsule consists of epithelial cells, the contents of which are cholesterol, lipid, and keratinized elements. Even spontaneous opening of a suppurating cyst and its temporary reduction does not indicate a complete cure. Over time, the ducts of the sebaceous gland will begin to clog again, the capsule will regenerate and fill with detritus.

Treatment of atheroma on the head can be carried out using the following methods:

1. Small cysts without signs of inflammation are removed on a planned basis:
   • Surgical method using a scalpel.
   • Laser method of removing atheroma.
   • Radio wave method of removing subcutaneous cysts.
2. Emergency treatment of atheroma on the head with inflammation:
   • Opening of the abscess.
   • Drainage.
   • Symptomatic treatment of local inflammation.
   • Enucleation of the cyst, usually using a scalpel.
3. Rehabilitation period:
   • When removing a simple atheroma of a small size, the stitches dissolve within 1-1.5 months without any visible cosmetic defect.
   • The laser and radio wave methods allow the procedure to be carried out in the most gentle manner, the incision is minimal, and healing occurs after 5-7 days.
   • Purulent atheroma is the most difficult in terms of healing after the procedure. A keloid scar is possible, which remains for a long time

Thus, the sooner the atheroma is removed, the lower the risk of purely cosmetic defects appearing on the scalp.

Removal of atheroma on the head

Removal of a sebaceous gland cyst in the head area is not difficult, the only specific nuance may be the need to shave a certain part of the hair during enucleation of a large atheroma, especially if it is inflamed or suppurating. Operations are performed on an outpatient basis under local anesthesia, general anesthesia is indicated only in extreme cases - for children under 5-7 years of age or patients with complications due to other diseases.

Methods that can be used to remove atheroma on the head:

1. Surgical method using a scalpel:
   • An incision is made in the most protruding part of the cyst, the detritus is squeezed out, and the capsule is removed using a special clamp.
   • The incision is made in the same way as described above, but the capsule is scraped out with a special instrument.
   • The incision is made without damaging the capsule, the skin is moved back, and the cyst is enucleated.
   • Several bordering incisions are made around the outlet of the cyst, the edges of the skin are placed in clamps, the cyst is enucleated within the healthy tissues and vertical cosmetic sutures are applied.
2. Laser removal of atheroma on the head is an absolutely painless method indicated for the neutralization of small cysts.
3. The radio wave method of removal is good because it does not require hair removal at the site of atheroma formation.

It should be noted that many patients have a false opinion about the completely non-traumatic procedure when using a laser or radio knife. This is not entirely true, in any case, the skin is cut, although in a more gentle and safe mode. The advantages of new methods are undeniable:

• Speed of operation (up to 30 minutes).
• Minimal blood loss, as coagulation occurs in parallel.
• Rapid tissue healing.
• Minimal scarring that resolves within a few weeks.
• Excellent cosmetic effect.
• No relapses.

All other stages, which involve the removal of atheroma on the head - removal of detritus together with the capsule, are similar to the traditional method using a scalpel. In addition, the laser is not indicated for the treatment of large atheromas, inflamed and suppurating cysts. The radio wave method has contraindications - the presence of pacemakers, metal implants, including metal dentures. The surgical method of removing a sebaceous gland cyst on the head is used for adult patients, children under 5-7 years old are subject to observation. In children, atheroma is removed only in case of inflammation or for other medical reasons.

In general, atheroma on the head is not dangerous for either the health or the life of the patient. However, in addition to a cosmetic defect, such a cyst is a neoplasm that can become inflamed or suppurate, which is fraught with complications in the form of an abscess of the scalp. Therefore, if atypical seals or lipomas appear, you should promptly contact a dermatologist, cosmetologist, trichologist, conduct a primary diagnosis and remove the atheroma on a planned basis.