Evaluation and Management of a Suprapubic Cyst and Nasal Scar in a 34-Year-Old Female
Patient Presentation
A 34-year-old female presented to our dermatology clinic in Katy, Texas, for evaluation of enlarging, irregular skin lesions located on the abdomen. The lesions had been present for several weeks and were described as new and progressively enlarging. She also expressed ongoing cosmetic concerns regarding a previously treated scar on her nasal dorsum.
Clinical Examination
A focused dermatologic exam was performed, including evaluation of the abdomen and nasal region. The patient was well-developed, well-nourished, and in no acute distress. Using dermatoscopic assessment, two primary findings were noted:
Residual Nasal Scar (L90.5):
The patient has a history of prior intralesional Kenalog (ILK) and CO₂ laser therapy to the nasal dorsum for scarring, with significant improvement noted. However, she reported persistent mild discoloration and slight depression of the scar. No evidence of recurrence or abnormal pigmentation was observed.
Plan: The patient was counseled that scars naturally become less noticeable over time but remain permanent features of the skin. Follow-up with her cosmetic surgeon was advised to explore potential refinements for residual cosmetic concerns.Epidermal Inclusion Cyst (L72.8) – Left Suprapubic Skin:
On physical examination, a 1 × 1.8 cm firm, subcutaneous nodule was identified on the left suprapubic region. The lesion was consistent with an epidermal inclusion cyst. Management options—including observation, oral antibiotics, intralesional corticosteroid injection, and surgical excision—were discussed.
After reviewing the benefits and potential for post-procedural scarring, the patient elected to proceed with intralesional Kenalog (ILK) treatment.
Procedure:Lesions injected: 2
Medication: Kenalog 10 mg/mL diluted to 4 mg/cc
Total volume injected: 0.1 cc
The risks of cutaneous atrophy and pigment alteration were reviewed, and the patient tolerated the procedure well. She was advised to monitor for redness, tenderness, or rupture.
Acne Vulgaris (L70.0):
The patient also reported mild inflammatory and comedonal acne. She prefers to focus on non-pharmacologic management, including dietary modification and stress reduction. We discussed evidence-based skincare approaches, including:Gentle, non-comedogenic cleansers and moisturizers
Broad-spectrum sunscreen SPF 30+
Topical retinoids for long-term acne control
Consideration of hormonal therapy (spironolactone) or isotretinoin if future exacerbations occur.
The patient was advised that visible improvement may take up to 2–3 months and to return if symptoms persist or worsen.
Discussion
This case highlights a multidisciplinary dermatologic approach addressing both medical and cosmetic concerns—a common scenario seen in dermatology clinics across Houston and Katy, Texas. Intralesional Kenalog remains a versatile treatment option for both cystic lesions and scar modulation, offering effective results with minimal downtime. Ongoing patient education and individualized treatment planning remain essential for achieving optimal outcomes.
Conclusion
The patient’s cyst was effectively treated with intralesional corticosteroid injection, and her nasal scar continues to improve post-CO₂ laser therapy. With continued observation and adherence to a gentle skincare regimen, her prognosis remains excellent.
