Hydrocystoma: what is it, causes and treatments

Hydrocystomas are benign lesions, usually asymptomatic, that cause cosmetic discomfort. However, they must be studied.

Last update: 22 September, 2022

Hydrocystoma is a benign cyst arising from sweat glands. It can be eccrine or apocrine, solitary or with multiple presentation.

Hydrocystomas contain fluid from the sweat glands trapped inside, without communication with the skin, so there is no emptying and they can increase in size as there is more fluid. They appear on the skin, predominantly on the edge of the eyelids (especially the lower eyelid), the cheeks, and the nape of the neck.

They appear more in people who live in hot and humid climates.

What is its cause?

Hydrocystoma is caused by obstruction of eccrine sweat gland ducts or by regrowth of apocrine sweat glands. Its exact cause is unknown..

They are associated with hot and humid climates, in which increased sweat production is required, which could clog the ducts. It also appears more in patients with hyperhidrosis, a condition characterized by excessive sweating.

Regarding hormonal causes, no association with Graves disease. In it, there is a hyperstimulation of the sweat glands due to the increase in thyroid hormones.

Situations of excessive and persistent sweating favor the blockage of the sweat gland ducts.

Hydrocystoma is asymptomatic

The reason for consultation is due to the presence of a cystic-shaped nodule causing aesthetic discomfort. Clinically, hydrocystomas appear as dome-shaped projections, usually translucent, but also pink, bluish, or brown in color.

Its surface is smooth and the liquid content is transparent. They can be solitary or multiple.

These can measure between 1 to 16 millimeters and grow or multiply with heat and moisture. When distributed along the eyelid margins they appear lighter in color.

They are more common in women and after the fourth decade of life. Hydrocystomas rarely occur in childhood and adolescence.

Definitive diagnosis is microscopic

Definitive diagnosis is by biopsy or by precise examination under the microscope.. Visually, hydrocystoma can be confused with other benign lesions, such as hemangiomas, lymphangiomas, dacryocystitis, or a simple dermal cyst.

Malignant lesions also enter the differential diagnosis, such as basal cell carcinoma or melanoma. They are especially similar to the first, which is why biopsy is key to exclusion.

Apocrine versus eccrine hydrocystomas

Eccrine hydrocystomas are smaller and have more tense walls. To a greater extent, they tend to be multiple. They predominate in women, on the cheek and around the eyes.

While apocrine hydrocystomas are usually solitary and larger than the previous ones. They predominate in the head and neck and near the palpebral corners and the palpebral edge.


In the case of a solitary hydrocystoma, it is removed simply surgically or with blepharoplasty surgery. Nevertheless, lancing and emptying may be used before attempting this methoddue to the risk of scarring.

Also, surgical removal can have recurrences.

When they are multiple, the application of topical atropine 1% with scopolamine creams is recommended. Cauterization or electrodesiccation of the wall, laser treatment, or carbon dioxide laser vaporization may also be used.

The capsule of hydrocystomas is thin, so may rupture and bleed at the time of examination or removal. In the event that this happens, it must be ensured that no capsule remains are left, since they cause a relapse of the lesion.

Only microscopic observation is capable of confirming the diagnosis of the lesion. Sometimes you have to resort to a biopsy.

These are rare injuries that require medical evaluation.

Hydrocystomas are rare cystic lesions that they represent part of the benign tumors of the sweat glands. It is small and translucent; cysts with fluid content inside may have a slight mobilization.

Your medical study is important. Due to its similar appearance to other more serious lesions, such as basal cell carcinoma, the appropriate differential diagnosis process is imposed.

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