Intralesional therapy for digital myxoid cysts: an updated scoping review

Digital myxoid cysts (DMCs) are common benign lesions that pose therapeutic challenges due to their proximity to the nail unit and association with joint pathology. While surgical removal remains highly effective, recurrence and procedure-related adverse motivate less invasive treatment options. Intralesional therapies, particularly sclerosing agents and steroids, are increasingly employed, but questions remain about their optimal use. This paper systematically synthesizes evidence on the efficacy, safety, and protocols of injectable therapies for DMCs, identifying knowledge gaps and opportunities for future research.

A scoping review was conducted in accordance with published guidelines. PubMed and reference lists were systematically searched (through September 2025) for English-language studies (three patients or more) reporting outcomes of intralesional therapies for DMCs. Data on agent type, protocol, response, recurrence, adverse effects, and cyst characteristics were tabulated and summarized.

Seventeen studies (N.=492 DMCs) were reviewed spanning 1977-2025. Agents used included steroids (62%), sclerosants (38%; primarily polidocanol and sodium tetradecyl sulphate), and minocycline. Complete response rates were 78% for sclerosants (90% including partial responders) and 56% for steroids (63% including partial). Recurrence after complete response was lower for sclerosants (12%) than steroids (46%). Adverse effects were generally mild and transient and included injection pain (19%), post-operative pain and/or inflammation (15%), superficial necrosis and/or crusting (6%), stiffness (4%), and rarely infection (1%).

Intralesional sclerosing therapies exhibit high efficacy and durability, with comparable safety profiles compared to surgery and cure rates approaching those of surgical management. Standardized protocols, longer follow-up, and comparative studies are needed to refine patient selection and optimize outcomes. These results support the incorporation of sclerosant therapies into shared decision-making algorithms for DMC management. Significant heterogeneity in study methods and outcome definitions, as well as short and variable follow-up periods, limit definitive conclusions.