Two for the price of one!
The DMC usually occurs in the periungual area. It often disrupts the nail matrix, making a groove in the skin. When punctured, a clear, viscous fluid may emanate. Fingers are more commonly affected than toes. The DMC is not a true cyst (with an epithelial wall). Instead, it is a pseudocyst.
Initially, one should try repeated draining with a sterile needle. If three or so drainings fail, surgical excision may be done. For some lesions, there is a connection with the adjacent joint space. One report suggested using methylene blue injection to guide the surgery [BJD 1998;suppl 51;p. 72]. One study found intralesional photodynamic therapy to cure all 10 patients with just one session (mean follow up 10.5 months) [JAAD 2017;76;359].
Polidocanol sclerotherapy was performed on 63 patients with a DMC. The DMC contents were extruded and 3% polidocanol (0.02-0.5 mL) was injected to gently refill the cyst to its previous size. Subjects were reviewed after 6 weeks and offered a second treatment if necessary, and reviewed again after 12 weeks. 68.3% experienced complete resolution of the cyst by 6 weeks, and 77.8% experienced complete resolution by 12 weeks. Side effects were minor and had resolved in all patients by 12-week review [Dermatol Surg. 2016 Jan;42(1):59-62].
DMCs often form grooves in the nail.
Digital mucous cysts on the toes. In the first picture, the DMC has been punctured and a clear viscous gel has been expressed.
Puncturing the DMC releases a thick viscous fluid.
Homepage | FAQs | Contact Dr. White