Atheroma: Causes, Symptoms & Treatment

Atheromas are benign (benign) soft tissue tumors that result from blocked excretory ducts of the sebaceous glands. Atheromas are harmless, but in many cases should be surgically removed to prevent infection.

What is an atheroma?

An atheroma (also known as a gruel pouch or wheat gruel) is a slow-growing, prallel-elderly cyst of the epidermis that is generally due to a blockage of the excretory ducts of the sebaceous gland system (sebaceous gland tumor). Accordingly, atheromas manifest themselves in most cases in areas with a large number of hair follicles, whereby the hairy scalp, neck, face as well as the pubic hair area are considered to be particularly predestined. Symptomatically, an atheroma only manifests itself in an advanced stage or in an unfavorable location by means of a feeling of tension in the affected area. In addition, many affected persons initially mistake an atheroma for a pimple and try to empty it. Due to these manipulations, infections of the atheroma can develop, which symptomatically resemble an abscess (redness, hyperthermia, swelling, pain) with pus formation (pus). In addition, atheroma of the skin is distinguished from vascular atheroma, which is a focal, inner-walled vascular deposit that correlates with arteriosclerosis.

Causes

Atheroma is caused by obstruction of the sebaceous gland excretory ducts. Causes of this blockage may include dried sebum or dead epidermal cells deposited in the sebaceous gland duct and clogging the excretory ducts. As a result, the sebaceous gland is no longer able to secrete the sebum required to lubricate the skin. More and more sebum, fat and skin cells accumulate in or below the epidermis and successively cause the manifestation of an atheroma. The triggering factors for the processes leading to the blockage cannot always be clarified. Because of familial accumulation, a genetically determined predisposition is assumed.

Symptoms, complaints, and signs

An atheroma usually leads to very unpleasant discomfort. In this case, the affected person primarily suffers from severe swelling in the affected region. This can thus lead to aesthetic discomfort, so that patients feel uncomfortable with the disease and ashamed of the discomfort. Redness may also occur and further aggravate the aesthetic discomfort. Many affected individuals also continue to suffer from severe pain and overheating of the affected area. An accumulation of pus can also occur in the process and possibly lead to inflammation. If the atheroma is not treated, it may also spread and affect neighboring regions. Many patients also suffer from high fever and, in the worst case, blood poisoning if the inflammation is not treated. Especially on the head, atheroma can be fatal in the worst case. In many cases, the pain from the region also spreads to the neighboring regions, so that there can be significant restrictions in everyday life. However, the symptoms also depend greatly on the exact extent and position of the atheroma.

Diagnosis and course

In most cases, an atheroma can be diagnosed by close skin inspection and palpation (palpation) of the cyst. A dermatologist should be consulted, if necessary, to differentiate it from potentially malignant skin lesions. After surgical removal, the removed tissue is usually examined histologically (fine tissue) to confirm benignity. In general, the prognosis and course of atheroma are very good, although recurrences may occur. Only in the case of an infected atheroma in the cheek or nose area is there a risk of the infection spreading to the area of the brain, since these structures are connected via the angular vein, through which the germs can also be transported.

Complications

An atheroma is usually harmless, but it can also lead to some complications. First, there is a risk that the cyst will become infected due to an ingrown hair, inappropriate treatment measures, or just pushing it around. A bacterial infection causes the atheroma to swell rapidly; depending on the location of the cyst, this can result in severe pain and an increased feeling of pressure. This is often accompanied by typical fever symptoms.If the atheroma presses on the nerve cords, sensory disturbances and numbness may occur in the affected region. The greatest danger is a bursting of the inflamed atheroma. This can lead to serious illness, including life-threatening blood poisoning. An atheroma on the head is particularly dangerous. If it bursts, bacteria and pus can enter the brain and cause further inflammation. If the atheroma is not inflamed, complications are usually limited to mild pain and a feeling of tightness in the skin. If inflamed, the gout sac continues to swell and the surrounding tissue area begins to ache and becomes sensitive to pressure. An inflamed atheroma should be treated promptly by a physician because of the sometimes serious complications.

When should you see a doctor?

An atheroma does not necessarily need to be treated by a doctor. However, if pain or severe swelling occurs, it is best to seek medical attention for the growth. Grütz pouches with pus formation also require medical clarification and treatment. Also, larger atheromas and those that persist for more than a few weeks or recur in the same area of the body should be treated medically. Growths in the intimate area, under the arms or on the face require rapid clarification, otherwise they can open up and become inflamed. If, in addition to the typical symptoms, fever, chills or other signs of illness also occur, the immune system may be overloaded. Medical help is absolutely necessary in this case. A reddish streak in the area of the atheroma indicates blood poisoning, which must be treated in the doctor’s office or in a hospital. If an atheroma becomes inflamed or reappears after self-treatment, a visit to the doctor is recommended more quickly. If left untreated, the growth can cause severe inflammation and infection or scarring. Patients with skin diseases should discuss atheromas and other skin lesions with their appropriate primary care physician.

Treatment and therapy

An atheroma is usually treated surgically, although surgical methods differ for noninfected and infected atheromas. Surgical removal of a noninfected atheroma is generally uncomplicated and is often performed as an outpatient procedure under local anesthesia or twilight sleep, depending on the size of the atheroma. In this procedure, the excretory duct of the sebaceous gland, which in most cases can be identified by a black dot located in the center of the cyst, skin spindle and the atheroma capsule are completely removed. Incomplete removal and opening of the capsule carries an increased risk of recurrence. Since this risk is particularly increased in an infected atheroma as a result of the inflammatory processes and complete excision of the capsule is not possible due to the doughy swelling, surgical intervention analogous to abscess is recommended here. In this case, the atheroma is first iced and then split. After careful removal of the pus (pus) and sebum, the affected area is additionally irrigated with an antiseptic agent and a drain is placed. If necessary, antibiotic prophylaxis is indicated to kill any bacteria that may remain in the body and prevent a new infection or recurrent inflammation. When the infection has resolved (4 to 6 weeks), the atheroma with capsule and excretory duct is removed during another surgical procedure. In more pronounced atheromas, a defect in the form of a dent may be present after surgical removal, which can be filled and sutured by displacement of the subcutaneous fat.

Outlook and prognosis

The prognosis for atheroma is generally considered to be very good. With proper medical care, the patient can be discharged from treatment as completely symptom-free within a short period of time. Normally, a physician performs an outpatient procedure so that the affected person can go home without assistance after only a few minutes or hours. The wound is treated sterilely and heals on its own over the next few days. A further visit to a doctor is usually not necessary. If the affected person removes the atheroma on his or her own without medical supervision, complications may arise. Inflammation and undesirable scarring are possible. In severe cases, there is a risk of contamination of the wound. Germs can invade the body and trigger various diseases.In the case of blood poisoning, there is also the threat of a fatal course of the disease. If the wound opens again during the healing process, pathogens can also enter the organism and lead to disorders. Although the healing prospects of an atheroma can be described as very favorable, it cannot be ruled out that further skin impurities may occur in the further course. Recurrence of an atheroma is possible and probable in many patients. Nevertheless, even with neoplasms, the prognosis does not change. Treatment remains the same and this is considered to be very successful.

Prevention

Since the manifestation of atheromas is congenital, they cannot be prevented. Even after complete and professional excision, recurrences, mostly in other areas of the body, can be observed in many cases. However, affected individuals should not attempt to manipulate existing atheromas (including by squeezing them), as this may provoke infection.

Here’s what you can do yourself

In the case of an atheroma, surgical treatment is usually performed. Although this is an uncomplicated procedure, the patient can still take some measures to avoid complications. First of all, it is recommended to take it easy on the body. Especially in the first days and weeks after the operation, rest is important. At the same time, the surgical wound must be carefully cared for. The patient should follow the doctor’s instructions and seek professional advice in case of unusual complaints. If the wound becomes infected, a visit to the hospital is indicated. In the event of a positive outcome, care should be taken to prevent the formation of further gout pouches. This can be achieved by treating the causative disease. Dry skin can be treated with the help of various care products from the specialized trade, while glandular diseases require medical examination and therapy. Basically, atheromas should not be touched or squeezed out by oneself, because this can cause infections and bleeding. In the worst case, the gland breaks open inward and blood poisoning occurs. Therefore, atheromas should be well observed and promptly examined by a medical professional who, in the best case, can directly perform an opening.