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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Many Small, Subcutaneous Cysts Around Anus Producing Yellow Odorous Discharge. Any Advice ?

Good Morning Dr. Grief,

I am currently uninsured, even though I have been a successful professional in the healthcare field for over 20 years. I know my question would be best directed at a Colon Rectal surgeon about my issue/condition as I have seen a private family practice physician and another physician at an STD clinic who happened to also be a dermatologist.

I have what appear to be numerous, small, subcutaneous cysts around my anus. I have successfully expressed a few of them over the past two years since they first appeared, and the sacs/cysts produce a yellowish, viscous sebum that is odorous. I'm of course embarrassed by the location of the cysts, and concerned about the number of them, and the possibility that they could be symptomatic of a more serious problem. They can itch, and if I try, which I shouldn't, to express them, it can cause pain and irritation. I haven't been able to successfully express any of them for a long time as many are deeper than others and have the ability to seemingly roll around under the tissue without a specific pore associated with them individually. Hygiene in the area isn't the cause as I'm diligent in keeping the area clean with showering and by using alcohol wipes following a BM if showering after isn't an option. I've tried granulated facial
exfoliation in the area, and even straight lemon juice, etc., as home remedies that don't seem to work. I do however produce sweat in the area because I do cardio at the gym at least a few times a week, but I clean the area immediately following.

I'm a 47 yr old male, and my facial skin tends to be more on the oily side, and can present black heads....which are easily dealt with because of location, and I commonly have some sebum build up on both sides of my nose in the creases between nose and face.

I'd appreciate your opinion and any advice you can offer. I know that this needs to be addressed one way or another for a variety of reasons from medical necessity to vanity. On a side note, I am gay and have a partner of nine years who I won't even alert to this because it's just gross and obviously embarrassing and potentially more serious than having black heads or cystic acne in the most horrible of places, especially when intimacy has been involved, at least a few years ago.
I apologize for that personal caveat.

Thank you
Fri, 31 May 2013
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Dermatologist 's  Response
Hi,
Thanks for writing to us.
So basically you are having perianal cystic lesions. The anal area contains oil glands, anal glands, eccrine sweat glands and apocrine sweat glands.
From the description I can think of two possibilities in your case sebaceous cyst or hidradenitis suppuritiva.
Sebaceous cyst is a cystic lesion underneath skin which is characterised by a central black keratin punctum and produces cheesy discharge on being squeezed. Treatment is surgical excision.
Hidradenitis suppuritiva is an apocrine gland pathology and presents as cysts and abscesses that lead to foul smelling thick discharge and heal with scars. It is also characterised by multiple blackheads in affected area and may be associated with severe acne. It can be treated with antibiotics, isotretinoin etc.
You need to consult a dermatologist and surgeon both to get the diagnosis confirmed.
Hope that helped.
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Many Small, Subcutaneous Cysts Around Anus Producing Yellow Odorous Discharge. Any Advice ?

Hi, Thanks for writing to us. So basically you are having perianal cystic lesions. The anal area contains oil glands, anal glands, eccrine sweat glands and apocrine sweat glands. From the description I can think of two possibilities in your case sebaceous cyst or hidradenitis suppuritiva. Sebaceous cyst is a cystic lesion underneath skin which is characterised by a central black keratin punctum and produces cheesy discharge on being squeezed. Treatment is surgical excision. Hidradenitis suppuritiva is an apocrine gland pathology and presents as cysts and abscesses that lead to foul smelling thick discharge and heal with scars. It is also characterised by multiple blackheads in affected area and may be associated with severe acne. It can be treated with antibiotics, isotretinoin etc. You need to consult a dermatologist and surgeon both to get the diagnosis confirmed. Hope that helped.