myxoid (mix-oid) mucous; resembling mucous; cyst (sist) a closed sack with a distinct membrane that develops abnormally. 

The body occasionally develops lumps and bumps that are filled with fluid. These growths are medically defined as “cysts.” Though peculiar, they are often painless. Two types of cysts that nail techs may see in the course of their day are the “ganglion cyst” and the “myxoid” or “mucous” cyst. Many times these can be confused as the same condition, but they are actually quite different.

“Ganglion cysts form when the joint-space lining herniates its way out from the joint space,” says Dr. Jerome Aronberg, a dermatologist in private practice in Clayton, Mo., and assistant clinical professor of dermatology at Washington University in St. Louis. “The ganglion cyst has a direct connection to the nearby joint space, and any treatment of this lesion should be undertaken with care, so as to prevent damage to the connected joint space.” The treatment would be to find the connection and ligate it or destroy it, says Dr. Aronberg. He notes that a ganglion cyst is found most often in people who have arthritic fingers, generally osteoarthritis, with bony spurs in the area of the joint spaces. The cysts most often form between the distal interphalangeal joint (the joint of the finger closest to the nail) and the nail plate. Treatment may require the attention of a hand plastic surgeon.

A myxoid cyst, also called a digital mucous cyst, is identified by the clear mucous that fills it. It’s a firm, smooth, rounded bump on the skin, often having a bluish tint. Inside, it is filled with clear, sticky, gelatinous fluid. The cysts appear most often on the fingers but can also show up on the toes. “The myxoid cyst generally  occurs in the proximal nail fold (the skin surrounding the cuticle),” says Dr. Aronberg. Cysts form from some sort of minor trauma to the site. The minor trauma can be caused by a repetitious act, including something as simple as typing or even repetitive rubbing of the area. A patient may not even be able to identify the cause.

The cyst may grow in a spot on the finger that is far enough away from the nail fold to prevent the nail from becoming distorted, but many times the cyst will cause the nail to change shape. When the cyst rests on top of the nail matrix, a depression or groove occurs on the nail plate, because of the pressure on the matrix, says Dr. Aronberg. “However, should the cyst happen to occur under the matrix, then the unit is forced upwards and the result is a bump in the nail rather than a depression,” he explains.

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Like most cysts, the myxoid cyst is generally painless, though complaints of aching may be voiced as cysts increase in size. It’s important to note that even without pain, care should be taken when bumps occur around the nail. Clients should always seek a medical evaluation because tumors, either benign or malignant, can also cause bumps on, or surrounding, the nails, cautions Dr. Aronberg.

Often the term “cyst” causes alarm and concern, but “it’s important to realize that these aren’t really ‘cysts,’ in that there is no cyst wall to the lesion, but rather it’s an area of collected gelatinous material,” says Dr. Aronberg. So, in actuality, these are “pseudocysts.” This is important to note because it means the cyst is treated differently than, say, an ovarian cyst. “A biopsy is not necessary, because there is no cyst to dissect out,” he says. “The typical clear gelatinous material that is expressed out of the cyst when they are lanced is sufficient to accurately diagnose them.”

Doctors treat the area with one of a variety of methods, including freezing, intralesional injections of cortisone, or multiple incisions and draining. “I will often have my patients do their own incision and draining of the cyst, followed by compressive dressings, though there is concern about the introduction of an infection into the site,” says Dr. Aronberg, “The average number of ‘stabbings’ before the area finally scars down is about six,” he says. Even after treatment, it is possible for the cyst to reappear.

Though patients may be able to drain the cyst themselves, it is still wise to have the growth checked by a doctor before making the initial incision to be sure the growth is actually a myxoid cyst and not something more serious. There are times when the cyst occurs directly under the nail plate, which may require the removal of part of the nail.   

WHAT’S A TECH TO DO?

If a client comes in with either a ganglion or myxoid cyst, educate her on the possibility of it being a cyst and suggest she consult her family doctor or dermatologist. Continue with services, being mindful to work gently around the cyst.

Though it’s possible for clients to puncture and drain the cyst at home, it’s not advisable for the tech to do it in the salon in case an infection develops after the client leaves the salon. “I would doubt that the cyst would rupture while the tech is working on the nail, as these are not really very superficial,” says Dr. Aronberg. However, in the unlikely event that the cyst does rupture, techs should squeeze out all of the gelatinous material, clean the wound, and apply a clean gauze to the area.