Digital mucous cysts are solitary, clear, or flesh-colored nodules that develop on the dorsal digits between the distal interphalangeal joint and the proximal nail fold. There are two types of digital mucous cysts: one type is associated with degenerative changes in the distal interphalangeal joint, and the second type is independent of the joint and arises from metabolic derangement of fibroblasts that produce large quantities of hyaluronic acid. The two types are clinically indistinguishable. The cysts can be asymptomatic, or they can cause pain, tenderness, or deformity of the nail. Aggressive surgical techniques to remove osteophytes from the joint can produce low recurrence rates. Other procedures to eliminate cysts, such as a simple surgical technique, cryosurgical destruction, or repeated needling, can be performed in an office setting. Read full text review.
Our favorite approach is repeated puncture or needling. Cure rates of up to 70 percent have been reported following repeated puncture and expression of cyst contents. Clear, jelly-like content, sometimes admixed with blood, squeezed from the cyst confirms the diagnosis. Puncture can be repeated with a sterile 20 – 25 gauge needle when the cyst becomes noticeable. We prefer puncturing the cyst with a # 11 surgical blade and teach patients how to perform this. Typically, a minimum of two to five punctures are needed for resolution of the cyst to occur. The advantage of this technique is that it does not need an office visit.
For background information about digital mucous cysts see DermNet.
Needling Reference:
A simple technique for managing digital mucous cysts. Epstein E. Arch Dermatol. 1979 115:1315-6.