Patient Presentation
A 16-year-old male came to clinic for his health supervision visit. He had noticed two small masses on the left scrotal skin. He had noticed them in the shower about a month previously. They were not changing in size or texture, were not painful, red nor swollen. He denied any obvious trauma, and hadn’t changed any soaps/detergents or hygiene products. He hadn’t been exposed to any plants. He also denied any specific restrictive clothing, except he wore cotton boxer brief-style underwear.

The past medical history was positive for mild acne vulgaris on his face and upper chest that was treated with benzoyl peroxide. He also had some folliculitis on his right upper thigh in the past year that was treated with mupirocin.

The pertinent physical exam showed a healthy teenager with normal vital signs and growth. His genitourinary examination showed 2 yellow-flesh colored nodules on his left scrotum near the thigh, that were approximately 5-8 mm in size without a punctum or erythema, or pain, and they were mobile. There were no other obvious lesions on dermatological examination. The surrounding skin appeared healthy. There were no masses on the testicles or phallus.

The diagnosis was unclear to the pediatrician. Although the nodules appeared benign, she was not sure what they were. “They look like some type of keratin inclusion cyst to me, but they are a little bigger and this is a different location than I usually see these,” she explained to the teenager and parents. A dermatologist, through an asynchronous electronic consultation thought that it was likely a syringoma or steatocytoma multiplex, and later made the diagnosis of steatocytoma multiplex during a subsequent office visit. The patient was treated by monitoring.

Discussion
Skin disorders or variations are one of the most common reasons for visiting a health care provider. Even from birth there are multiple different variations of differences in skin. As the skin is the largest organ and readily visible, patients have concerns that skin changes may be the presenting symptom of a systemic illness. The skin is also one of the major protective factors for the body and therefore the normal wear and tear and exposure of the skin can cause a range of different skin problems that may need treatment.

The differential diagnosis of small skin nodules similar to steatocytoma multiplex includes:

• Acne vulgaris
• Acne conglobata
• Adenoma, sebaceous
• Dermoid or epidermoid cysts
• Follicular infundibular tumors
• Hidradenitis suppurativa
• Lipoma
• Milia
• Sebaceous hyperplasia

Learning Point
For Images – see To Learn More below

• Steatocytoma multiplex (SM)
  • Pilosebaceous gland disorder
  • Presents with asymptomatic, multiple, sebum containing, dermal cysts that are yellow or flesh colored, and has freely moving papules/nodules. There is a variation where there is some inflammation called SM suppurativa which has risk of infection and scarring. Steatocytoma simplex is a solidary lesion.
  • No malignant potential
  • Occurs in mainly 2nd and 3rd decade but can occur in any age group
  • Most cases are sporadic but there is an autosomal dominant form
  • Locations where pilosebaceous glands are prominent – arms, axilla, face, scalp, thighs, trunk, and less commonly breasts and genitals
  • Numerous lesions can occur over time and currently there is no preventative treatment
  • Treatment includes education and monitoring, laser, needle aspiration, cryotherapy, tretinoin cream
• Syringoma
  • Adnexal tumor of the (presumably) eccrine sweat gland (presumably)
  • Asymptomatic, multiple, yellow or flesh-colored papules that can be hyperpigmented, often 1-3 mm in size but can be larger, and can occur in groupings or have solitary lesions.
  • No malignant potential
  • Occurs in mainly 2nd and 3rd decade but can occur in any age group
  • Most cases are sporadic but there is an autosomal dominant form
  • Locations face (especially upper cheeks and lower eyelids), axilla, neck, chest, umbilicus and genitals
  • Treatment includes education and monitoring, atropine sulfate, tretinoin cream, cryotherapy, excision

Questions for Further Discussion
1. What are the worrisome ABCs of skin lesions? A review can be found here
2. What are epidermal cysts? A review can be found here
3. How is hidradenitis suppurativa treated? A review can be found here

Related Cases

Disease: Steatocytoma multiplex | Benign Tumors | Skin Diseases

Symptom/Presentation: Mass or Swelling

Specialty: Dermatology

Age: Teenager

To Learn More

To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews. Information prescriptions for patients can be found at MedlinePlus for these topics: Benign Tumors and Skin Conditions.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images – Syringoma.

To view images related to this topic check Google Images – Steatocytoma multiplex.

To view videos related to this topic check YouTube Videos.

Petersson F, Mjornberg PA, Kazakov DV, Bisceglia M. Eruptive Syringoma of the Penis. A Report of 2 Cases and a Review of the Literature. The American Journal of Dermatopathology. 2009;31(5):436. doi:10.1097/DAD.0b013e3181930d93

Varshney A, Aziz M, Maheshwari V, et.al. Steatocystoma multiplex – PMC. Accessed July 28, 2025. https://pmc-ncbi-nlm-nih-gov.proxy.lib.uiowa.edu/articles/PMC3185371/

Georgakopoulos JR, Ighani A, Yeung J. Numerous asymptomatic dermal cysts: Diagnosis and treatment of steatocystoma multiplex. Can Fam Physician. 2018;64(12):892-899.

Singh A, Oakley A. Syringoma. DermNet®. October 26, 2023. Accessed August 5, 2025. https://dermnetnz.org/topics/syringoma

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa