Differentiating cystlike nodules
A 35-year-old Asian man noted numerous subcutaneous nodules and cysts he’d had since puberty. The nodules ranged in size from 2 mm to 2 cm and manifested on his back, chest, and abdomen. Some were flesh-colored and some had a yellow hue. The nodules did not itch, burn, or sting and were not painful. From time to time, they would become inflamed and surrounded by redness. Five years before, another dermatologist had incised and drained the nodules several times, expressing a viscous fluid each time. No other family members had similar eruptions.
The patient, a 40-year-old Caucasian man, came to the dermatology clinic for treatment of a blue-gray nodule he had first noticed six months before. The nodule was about 1 cm in diameter and had a central punctum. It did not itch, burn, or hurt. The patient stated that he thought his father had had nodules similar to this one. Squeezing the area around the nodules led to the expression of a cheesy material with an unpleasant odor. The patient took amlodipine (Norvasc) for mild hypertension and atorvastatin (Lipitor) for high cholesterol.