Hidrocystoma (apocrine and eccrine)
Sudoriferous cyst; cyst of Moll; Moll-gland cyst (apocrine variant)
Hidrocystoma is a common benign cystic adnexal lesion of the periocular region — most commonly the medial canthus or lid margin — that arises from sweat-duct epithelium. The apocrine variant (cyst of Moll) is usually solitary, larger and translucent blue-grey; the eccrine variant tends to be smaller, flesh-coloured and may be multiple, particularly on the cheeks of women working in hot or humid conditions. Multiple hidrocystomas in association with palmoplantar keratoderma, hypotrichosis or hypodontia should raise suspicion of Schöpf-Schulz-Passarge syndrome.
Clinical features
- Apocrine hidrocystoma (cyst of Moll) — solitary translucent blue-grey, dome-shaped cyst, 3–15 mm, on the medial canthus, lid margin or temple. Slowly grows; may fluctuate with heat.
- Eccrine hidrocystoma — multiple smaller (1–5 mm) flesh-coloured to faintly blue papules on the cheeks, lower eyelids, periorbital area; may worsen in summer / heat.
- Both — middle-aged and older adults; women slightly over-represented.
- Usually asymptomatic; occasional obstruction of the lacrimal punctum.
Histology
- Apocrine — unilocular cyst lined by a double layer of cuboidal/columnar epithelium with decapitation secretion (apical snouts) and an outer myoepithelial layer.
- Eccrine — unilocular cyst lined by two layers of low cuboidal cells without decapitation.
- Both variants lack atypia and show no significant inflammation.
Differential
- Milium — superficial, white, keratin-filled.
- Epidermoid cyst — central punctum, firmer.
- BCC, particularly pigmented or cystic variants — pearly border, vessels.
- Periocular blue naevus.
- Apocrine adenoma / hidradenoma papilliferum (in genital area).
- Schöpf-Schulz-Passarge syndrome — multiple eyelid eccrine hidrocystomas + palmoplantar keratoderma + hypodontia / hypotrichosis (autosomal recessive).
Management
- Reassurance for asymptomatic typical lesions.
- Solitary apocrine hidrocystoma — simple excision via small ellipse; recurrence uncommon.
- Multiple eccrine hidrocystomas — limited options:
- Cool environment, avoid heat / humidity exposure.
- Topical anticholinergic agents (glycopyrronium).
- Botulinum toxin injection has been used.
- Light electrodesiccation, trichloroacetic acid, CO₂ laser — care to avoid eyelid scarring.
- Refer for genetic assessment if multiple lesions and other ectodermal features.
References
- Smith JD, Chernosky ME. Hidrocystomas. Arch Dermatol; 1973.
- Sarabi K, Khachemoune A. Hidrocystomas — a brief review. MedGenMed; 2006.
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