An 18-Month Follow-Up of Digital Myxoid Cysts After Therapy With Percutaneous Sclerotherapy With Polidocanol

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Treatment for digital myxoid cysts (DMCs) constitutes a therapeutic challenge mainly because of the high recurrence rates of traditional treatments used.1,2 Polidocanol (POL) is a detergent used as sclerosant agent. Percutaneous sclerotherapy with POL has been presented as an alternative therapy with promising results at short term. In 2008, Cordoba and colleagues3 presented 6 cases of DMC treated with POL 2% achieving a complete response rate (CRR) of 100% evaluated at 6 months follow-up. Recently, Esson and Holme published 63 cases of DMC treated with POL 3% and a CRR of 77.8% at 3 months follow-up.4 No data of long-term follow-up has been published so far. After incorporating POL for the treatment of DMC in our department, we have evaluated the results of this therapy with the novelty of a median follow-up of 18 months (Figures 1 and 2).
We have treated 15 lesions in a total of 13 patients. Five patients (38.5%) were men and 8 (61.5%) were women. The median age was 57 years (range 42–72 years). The mean lesion size was 5.2 mm (range 2–8 mm). Thirteen lesions (86.7%) were located on the fingers and 2 lesions (13.3%) on the toes. Eight lesions had recurred after previous therapies: surgery had been performed on 5 lesions, cryotherapy on 1 lesion, surgery, and cryotherapy on 2 lesions. Seven lesions had never been treated before. The sclerotherapy method was similar as described in the previous mentioned articles. Nevertheless, we punctured the lesion with a 25-G needle and we emptied it doing a light manual pressure and then, we infiltrated the necessary volume of POL 2% to fill the DMC (In general less than 0.1 mL).
We observed CRR (complete resolution of the DMC) in 12 lesions (80%) and a partial response rate (defined as a reduction >50% of the DMC size) in 3 lesions (20%). The median number of necessary infiltrations to reach CRR was 1 (range 1–4). The median follow-up time was 18 months (range 3–24 months). Among the lesions which finally reached CRR, only one recurred (8.3%). The recurrence time was 18 months.
Adverse reactions (ARs) related to this technique were minor in our experience. Patients reported outcomes: level of pain, level of satisfaction, etc. Moreover, physicians ruled out complications (such as infection and inflammation). During the procedure 87% of patients referred null to light pain and 13% moderate to severe pain. Most patients in the days after the procedure had light to moderate inflammation or light to moderate localized pain. 66.7% of treated lesions showed a faint scar as a later AR. We have not registered any joint or tendon injury. Finally, we evaluated the level of satisfaction with the technique. The visual analogic scale (0–10) was 9.4.
Our results confirm previous publications in terms of efficacy, highlighting a good recurrence control with a median follow-up of 18 months. According to our knowledge only results of short-term control have been previously published. Therefore, we would like to focus interest on this fact since currently one of our main concerns regarding DMC therapy is recurrences.
In conclusion, although more clinical trials are needed, our experience suggests that sclerotherapy with POL in an effective, safe, simple, and affordable procedure when treating DMC.
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