KISTA EPIDERMOID

CHAPTER I
INTRODUCTION

Cysts are formed by epithelial berskuamosa is the most common cause of all cysts on the skin surface. Epidermoid cyst is a benign tumor, originating from the follicle, which is often found. (4)
The subcutaneous epidermoid cyst is a chewy, can fluctuate, it can be moved from their foundations and are usually found on the face, neck, extremities, genitalia and tools. Vary in size from 1 millimeter to several centimeters. Can find any point (punktum) at its center, so patients usually report a drainage brupa keratin masses. When these cysts usually appear on the genitalia of calcification. (3,8)
Milia, the smallest papular lesions on the face, is also histologically epidermoid cyst. Milia can occur either in single or multiple. (2)
Mothers of newborns are also often surprised by the appearance of spots white spots on her face that it is milia. The question that often arises is whether an infectious disease? Is the disease curable? (6)
Keratosis is a clinical term that is often used for all lesions caused by increased formation of keratin which is not caused by an inflammatory process. (2)
In histopathologic, keratosis term can not be accepted as a clinical diagnosis, because seborrheic keratosis is a papilloma and more accurately described as a seborrheic verruca. Nevertheless the term still used keratosis. (8)
Seborrheic keratosis is a benign lesion that has a shape like a mole that is caused by the proliferation of epidermal keratinocytes. (5)
There is no tendency that these lesions can become malignant. Usually the removal of milia and the indication of seborrheic keratoses is cosmetic, but patients also must be reminded that a new lesions will continue to grow. (3)

CHAPTER II
Milia

2.1. Definition

Milia is a cyst containing keratin, measuring 1-4 mm, and usually appear on the face, especially under the eyes. (4)
Montgemery milia describe as globoid mass of pearly white, which usually arise as a grain of rice between the layers of translucent tissue. (3)

2.2. Epidemiology

Milia can occur in everyone from newborns to adults. There was no significant difference between men and women. (7)

2.3. Etiology

Primary milia usually occur in newborns, therefore it is considered the cause is the formation of sebaceous glands are not perfect. However the primary milia can also appear there children and adults. (1,3,6)
There are other opinions that say that the milia in newborns caused by excessive sebum production. In the mother the baby's body there is a hormone that stimulates the sebum produced resulting in overproduction of sebum. This excess sebum cause the baby's skin is difficult to make the process of cleansing itself of dead skin cells. Dead skin cells will be trapped in pores and cause the formation of facial milia. (2,4)
Secondary milia arise following the occurrence of trauma that damage the ducts of sweat glands, and dermabrasion. Radiotherapy which destroy the structure of the skin can also cause milia around the treated area. (8)
Secondary milia can also be caused by the use of high potency topical corticosteroids for a long time or after 5-FU therapy. (6)

2.4. Histopathology

Primary milia showed a picture of epidermoid cyst in a smaller size. Milia usually found in the superficial layers of the dermis and has a complete epithelial layer. Milia contain keratin in varying amounts. Primary milia in newborns and young children were found around the sebaceous glands around the hair follicles.
Secondary milia provide an overview of the gland duct dilatation of ekrin. (1,3)

2.5. Clinical symptoms

Milia are asymptomatic lesions that are often found on the face of the newborn. (4)
Primary milia in newborns is often found on the face, especially around the nose and chin, the forehead and cheeks rarely. Milia can also be found on the upper extremities, genitalia, skin and mucosa of the palate. Lesions on the palate are called Epstein Pearls. (2,3)
Primary milia in children and adults are usually also present on the face, especially around the eyes.
Secondary milia can be found throughout the body is exposed to predisposing factors. (4)

Figure 1. Clinical picture contained milia around the eyes

Milia is superficial, uniformis, pearly white to slightly yellowish, shaped like a cone and a diameter of 1-4 millimeters. Usually located in groups. (1,6)
Milia in newborns can go away by itself within a few weeks, but sometimes the new away after the baby is 3 months old. (5)

2.6. Diagnoses

Milia be distinguished from acne vulgaris, syringoma, and trichoepitelioma.
Acne vulgaris has a predilection for the face, shoulders, upper chest and upper back. Skin eruptions that appear polymorphic with predominant symptoms of blackheads, papules, pustules, nodes, or cysts.
Syringoma is a benign tumor caused by abnormal gland ekrin. Syringoma lesions in the papule measuring less than 3 millimeters in the same color as the skin until golden. Syrigoma predilection is below the crease of the eye and chin.
Trichoepitelioma are benign tumors of skin adnexa caused by genetic abnormalities. Genetic abnormality occurs on chromosome 9, where the chromosome 9 has a shorter arm. Shaped papule or nodule lesions, round, flesh color, measuring 2-8 millimeters. Predileksinya adlah nasolabial folds, nose, forehead, upper lip, and scalp. Lesions rarely occur in the neck and body. (1,3,4,7)

Of 2.7. Management

Milia in newborn infants do not need to be treated because it can disappear by itself within a few weeks.
No topical or systemic medications that disappear efekif for both primary and secondary milia. (4)
Milia can be left and did not pose a hazard, but usually patients want treatments to cosmetic reasons. Actions taken in the form of incisions or removing the contents of milia using a blackhead extractor. This can be done without anesthesia depending on the location and level of patient tolerance. (5


CHAPTER III
Seborrheic keratoses

3.1. Definition

Seborrheic keratosis is a benign lesion on the skin surface that has a shape like a mole and is caused by the proliferation of epidermal keratinocytes. (2)

3.2. Etiology

The exact cause of seborrheic keratoses is unknown.
There are opinions that say that heredity plays an important role. In individuals who have a genetic predisposition, the formation of seborrheic keratoses can also be triggered by actinic damage (actinic damage) and sometimes other forms of skin lesions such as drug eruption.
Some are saying that chronic exposure to sunlight is the cause. The process is caused by the cumulative effect of solar radiation energy. most cases a white mareka attack and exposure to sunlight. (1,4,6,8)

3.3. Histopathology

In histopathologic seen the acanthosis, elongation of the body interpapilari, and a small epithelial cyst formation caused by invagination of the epidermis. (3)
Is little cell mitosis.
Usually look a little inflammatory reaction in the skin. (6)


Figure 1. Histopathological picture of keratosis seberoik

3.4. Clinical symptoms

Seborrheic keratoses can occur on the entire surface of the skin. However, most often found on the face, back, sternal region, extremities, and the inflamed area. When there are multiple lesions, usually bilateral and symmetrical distribution is. (3,5)
Seborrheic keratoses lesions appear as multiple papules or plaques form a rather prominent, but can also be seen attached to the skin surface. These lesions are usually covered by a dry, somewhat oily skin and are usually easily separated. (4)
They usually have the same pigment that is brown, but sometimes also found that black or bluish-black colored.
Surface of the lesion is usually berbenjol bumps. Lesions that have a smooth surface is usually contained keratotic tissue resembling grain. (5)

Figure 2. Solitary lesions of seborrheic keratosis
Lesions usually occur in more than 40 years of age and continue to grow as we age.

Figure 3. Clinical picture of seborrheic keratosis on the neck

Seborrheic keratoses usually are asymptomatic, but can sometimes merjadi itchy and inflamed. In some individuals the lesions may grow large and thick, but rarely off by itself. (7)
Trauma or rubbing hard can cause lesions of the top off, but it will grow back by itself. (2)
There is no tendency for berudah toward malignancy.
There are two types of seborrheic keratosis. The first is irritated seborrheic keratosis which give symptoms such as lesions that are erythematous and sometimes itchy. The second is papulosa nigra dermatosis that usually appears in individuals who were black. Lesion appears as a papule berwrna blackish brown in various sizes. Usually found on the face and neck. (3)

3.5. The differential diagnosis

Seborrheic keratosis senile keratosis must be differentiated. Seborrheic keratoses is more superficial and more soft than senile keratosis, as well as easier to be released.
To distinguish them from melanoma, a skin biopsy is necessary. Biopsy will indicate the presence of epidermal papillary hyperplasia and papillary melanocytes. (2,6)

3.6. Management

No action was conducted in the absence of bullet tendency to turn into malignancy.
Action is usually carried out on cosmetic indications in the form of curettage with local anesthesia ethyl chlorine. Can also be frozen with liquid nitrogen surgery without anesthesia, or by using a carbon dioxide freezing solid.
Before the appointment, patients should be informed that a new lesions will continue to emerge. (4)

CHAPTER IV
CLOSING

Milia is a cyst containing keratin, measuring 1-4 mm, and usually appear on the face, especially under the eyes. (4)
Milia can occur in everyone from newborns to adults. There was no significant difference between men and women. (4)
Primary milia usually occur in newborns, and is considered the cause is the formation of sebaceous glands that are not perfect or excessive sebum production. (5)
Secondary milia are caused by trauma that damages the ducts of sweat glands, skin abrasion (dermabrasion), radiotherapy, high-potency topical corticosteroids for a long time or after 5-FU therapy. (8)
In primary milia showed histopathologic picture of epidermoid cyst in a smaller size. Secondary milia provide an overview of the gland duct dilatation of ekrin. (2)
Milia is superficial, uniformis, pearly white to slightly yellowish, shaped like a cone and a diameter of 1-4 millimeters. (1,3,6)
Primary milia in infants was found on the face, especially around the nose and chin, the forehead and cheeks rarely. In children and there around the eyes.
Secondary milia can be found throughout the body is exposed to predisposing factors. (7)
Milia in newborn infants do not need to be treated because it can disappear by itself within a few weeks. No topical or systemic medications that disappear efekif for both primary and secondary milia. (4)

Milia can be left and will not cause harm, treatment is usually performed by cosmetic reasons. Action taken is the incision or remove content milia using a blackhead extractor. (5)
While seborrheic keratosis is a benign lesion on the skin surface that has a shape like a mole and is caused by the proliferation of epidermal keratinocytes.
The exact cause of seborrheic keratoses is unknown. There are opinions that say that heredity plays an important role as well as chronic exposure to sunlight is the cause. (3,8)
In histopathologic seen the acanthosis, elongation of the body interpapilari, and a small epithelial cyst formation caused by invagination of the cell mitosis epidermis.Hanya look a little. Usually look a little inflammatory reaction in the skin. (3)
Seborrheic keratoses can occur on the entire surface of the skin. However, most often found on the face, back, sternal region, extremities, and the inflamed area.
Seborrheic keratoses lesions appear as multiple papules or plaques form a rather prominent, but can also be seen attached to the skin surface. They usually have the same pigment that is brown, but sometimes also found that black or bluish-black colored. Surface of the lesion is usually berbenjol bumps but can also have a smooth surface. Lesions usually occur at the age of 40 years and counting. (3,4)
Seborrheic keratoses usually are asymptomatic, but can sometimes merjadi itchy and inflamed.
Trauma or rubbing hard can cause lesions of the top off, but it will grow back by itself. (4,7)

No action was conducted in the absence of bullet tendency to turn into malignancy. Before the appointment, patients should be informed that a new lesions will continue to emerge. Action is usually carried out on cosmetic indications in the form of curettage with local anesthesia in the form of chlorinated ethyl, frozen with liquid nitrogen surgery without anesthesia, or by using a carbon dioxide freezing solid.