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Massage Today
November, 2006, Vol. 06, Issue 11

Cysts, Cysts, Cysts!

By Ruth Werner, LMP, NCTMB

Dear Readers:

My last article on psoriasis generated a lot of conversation and feedback from readers struggling with this condition, or who have clients who do. I will include one excerpt here:

Dear Ruth,

Thank you so much for your articles! I have had pustular psoriasis on just my right foot for 25 years; thank you for being the first person to name it for me.

Because it did not look like psoriasis, I did not make a connection. Now, if I have breakouts, they are mild. To keep my foot at bay, I must really watch my diet. If my digestion is off, so is my foot. Although I joyfully eat everything, it is best that I avoid the big four: sugar, wheat, corn and dairy. If I indulge, I won't get a reaction on my foot immediately, but soon. I call my foot my "health barometer."

Hope this helps someone. Thank you again.

Marcia Ferry

Note: I won't use this space to advertise products, but Marcia has generously provided her Web site so interested readers can get more information from her on options for psoriasis treatments.

Also, in my last article, I put out the call for topics and you have come through in a big way. I have lots of possibilities to consider, but for some reason this letter struck home for me, so this will be the topic for today:

Dear Ruth,

I have been seeing many clients in the past six months with cysts or lumpy masses under the skin. I always refer them to a doctor if I feel anything, but I would like to have a better understanding of cyst pathology. I have felt cysts the size of a small tomato to the size of a pea. Some clients say their doctors say it's nothing. How do they know? I had one client whose doctors said he had calcium deposits throughout his body. I just finished with a client who had a cyst over the spinous process at T12. She did not know about it. I would like to have a better understanding of anatomy, types, prevalence, contraindications, causes and potential treatments of cysts. How can we palpate a difference between them?

Sarah Gerschutz, LMT

Dear Sarah, 

Cysts are an interesting topic because they can occur anywhere, from any number of causes. This discussion will be limited to cysts that occur in the skin and are palpable to massage therapists. This list includes sebaceous cysts, ganglion cysts and lipomas, with a little more information on the vague diagnosis of "calcium deposits."

Sebaceous cysts: Sebaceous cysts develop where the body grows a connective tissue wall around a deep acne infection. The term "cystic acne" refers to the tendency to form these pockets of dead bacteria and white blood cells in the superficial fascia. Unfortunately, the cysts can outlast the infection by months or longer. Some people still have cysts many years after acne is a significant issue for them. They generally are painless, hard and small, and are deeply embedded in the superficial fascia of areas where acne is prevalent: on the face, around the jaw line, the upper back and the chest.

It is extremely unlikely that a massage therapist could ever rupture a sebaceous cyst; by the time the acne has cleared, the cysts probably are more connective tissue container than contents. Nonetheless, here as everywhere, we are guided by our clients' comfort levels. Don't try to "melt" these with static pressure - they aren't trigger points and they won't go away with a deep breath.

Ganglion cysts: Ganglion cysts are pouches that grow on tenosynovial sheaths. They usually occur on the hands or feet, either at the wrist or ankle, or at the distal phalanges. In rarer circumstances, they can grow at other tenosynovial sheaths: I once saw one on the Achilles tendon of a clog dancer. They can be mildly painful, mostly from the irritation of friction and being bumped around a lot.

Ganglion cysts can be small enough to be silent, or they can grow to be as big as a golf ball. Depending on where they grow, they can interfere with movement and when they are on the fingers, they can distort the growth of the fingernail. Some readers might remember the "olden days" remedy for ganglion cysts: to whack it with the biggest book in the house, which usually was a bible. The "bible treatment" also can cause lots of other injuries, so nowadays surgery generally is recommended instead. The surgery to correct ganglion cysts is simple and usually successful, although in rare cases they might grow back.

Massage won't eradicate a ganglion cyst (unless it's much deeper than most people tolerate!), and deep friction in the area can be extremely irritating. Consequently, we treat these as local cautions and simply avoid strokes that are likely to be painful.

Lipomas: Lipomas are benign, fatty tumors that grow in many places throughout the body. They often occur on the skin, but also have been found deep in muscle tissue, in breast tissue, in the GI tract (where they can create a serious obstruction) and on some internal organs, including the liver, adrenal glands and kidneys. Internal lipomas can be difficult to distinguish from cancerous growths, which make them a bit alarming.

Lipomas that grow in the skin usually appear on the head, neck, shoulders and back, but one type is associated with proximal limbs, where they incorporate local sweat glands into their structure. From my own experience, they also are frequently found around the sacrum and iliac crest. They occasionally appear after blunt trauma. In women, lipomas tend to appear singly, but in men they might appear in groups. They usually are painless. They grow slowly, if at all, and have little to no risk of developing into cancer.

Lipomas have some distinguishing palpable qualities. They grow in superficial fat, so they are trapped between skin and deeper fascia. They can range in size from tiny to enormous (I once had a client whose lipoma took up most of the central portion of her back, so giving her a massage was a special challenge!). Skin slides easily over the top of most lipomas, and they are soft and malleable.

The cysts described in the letter from Sarah sound like lipomas, but she is correct to refer these clients to their primary health care providers for more information. Lipomas usually are diagnosed through palpation and the patient's history; typically, they've been present for a long time, and are painless and stable. If they become painful or suddenly change in size or shape, this is, of course, a good reason for another visit to the doctor. But for the vast majority of people, lipomas are a slightly inconvenient anomaly, and they don't require attention or treatment.

When lipomas are treated, however, they are removed through excision or liposuction. Small ones might be injected with steroids to destroy and shrink the fatty tissue. They don't usually grow back. When we find lipomas, the best approach is to treat them as a very local contraindication: we can work normally in the area as long as we don't irritate the fatty cyst. It always is wise to bring these to the attention of clients who might not know they're there, but unless the lipomas are painful and inflamed, we don't need to treat these as a serious problem.

Calcium deposits: In her letter, Sarah also told me she now has two clients whose doctors told them their cysts were "calcium deposits" in the skin. I looked into this phenomenon, and here's what I found: When fat cells die off inside a cyst, a calcium deposit might form. This has been reported in internal lipomas, but I haven't found reference to this process in skin cysts. Sometimes scar tissue calcifies, but this happens most often in tendons rather than skin or superficial fascia. Scleroderma, dermatomyositis and systemic lupus are all autoimmune diseases that can involve the development of calcium deposits in the fingers; this is called calcinosis. These are all serious and complex disorders; however, I doubt they were the cause of the lesions Sarah described. It is more likely that the calcium deposits, if that's what they are, are related to old acne lesions or scar tissue, and as long as massage doesn't irritate them, they can be ignored. The important thing is that the clients were evaluated by a primary care physician to rule out anything more serious.

For Next Time

I asked, you answered. I have several topics I could discuss next time, all of which have lots of possibilities. For the moment I'll narrow it down to these choices:

  • eczema and its relationship to the risk of secondary skin infections;
  • lupus, an autoimmune disease that involves attacks against virtually every type of tissue;
  • chronic fatigue syndrome (especially as it relates to Lyme disease); or
  • anything else you'd like to share with other practitioners.

Write and let me know what you'd like to see: What's on your table? Until then, many thanks and many blessings.

Click here for previous articles by Ruth Werner, LMP, NCTMB.


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