search
for
 About Bioline  All Journals  Testimonials  Membership  News


Indian Journal of Dermatology, Venereology and Leprology
Medknow Publications on behalf of The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL)
ISSN: 0378-6323 EISSN: 0973-3922
Vol. 72, Num. 3, 2006, pp. 247-248

Indian Journal of Dermatology, Venereology and Leprology, Vol. 72, No. 3, May-June, 2006, pp. 247-248

Quiz

Numerous yellow-brown papules over the trunk

Departments of Dermatology, Fatih University Faculty of Medicine, Ankara
Correspondence Address:Department of Dermatology, Fatih University Faculty of Medicine, Alpaslan Turkes Caddesi No.: 57, 06510, Ankara, evrenmd@yahoo.com

Code Number: dv06085

A healthy 17-year-old white girl presented with numerous discrete brown to yellow colored papules that had arisen on the trunk 2 years earlier. The lesions were mildly pruritic. She was not on any medications at the time. Physical examination disclosed numerous skin-colored to yellow-brown 2-4 mm ovoid papules scattered over the anterior aspect of the thorax, mostly below the breasts and over the mid-abdomen [Figure - 1]. A few lesions were seen in the axillae and on the anterolateral surface of the neck. The patient did not have other clinical cutaneous or systemic findings.

A skin biopsy specimen obtained from the abdomen of the patient revealed small ducts and epithelial cords within a dermis of normal-appearing connective tissue. The ducts were lined by two rows of flattened epithelial cells, the outer layer bulging outward to form solid chords [Figure - 2][Figure - 3].

What is your diagnosis?

Diagnosis: Eruptive syringoma

Discussion

Syringoma is a benign tumor of eccrine origin, first described by Biesiadecki and Kaposi[1] showing a differentiation toward intraepidermal eccrine ducts. Eruptive syringoma is a somewhat rare clinical variant, where numerous papules arise in successive crops on the anterior surface of the body.[1],[2]

The skin lesions of syringoma consist of yellow to flesh-colored to brown 1-5 mm papules, which are commonly found on the eyelids. Other characteristic sites include the neck, chest, axillae, antecubital fossae, upper extremities, lower part of the abdomen and groins. They occur predominantly in women and may develop at any age, with a peak incidence between the third and fourth decades.[3] Histopathologically, the epithelial component of the proliferation is composed of cells with pale or pinkish cytoplasm arrayed as nests and tubules of relatively uniform size. Depending upon the exact plane of section, the nests of syringoma vary in shape and some nests may resemble a comma or a tadpole.[4]

Eruptive syringoma may clinically resemble lichen planus, flat warts, papuler mucinosis, xanthoma disseminatum and mastocytosis. However, the diagnosis can be easily made with the distinct histopathological findings.

Therapy for syringomas is unsatisfactory. Surgical, oral and topical treatments have shown limited results. Due to the number of lesions, electrocoagulation and cryotherapy are too laborious, yielding poor cosmetic results.[3] Symptomatic eruptive syringomas have shown poor or no response to topical and oral corticosteroids, topical antifungal agents and topical retinoids.[5] Successful treatment with 1% topical atropine resulted in disappearance of the pruritus and in a reduction in the size of the lesions.[6] However, the limitation of this treatment was that the patients had to be carefully evaluated for the side effects of atropine such as blurred vision, headache, palpitation, difficulty in micturition, reduced intestinal peristalsis, etc.

We have treated our patient with topical tretinoin. After 1 month, there was a significant improvement in the lesions; however, new lesions appeared during treatment. Although spontaneous involution of the lesions have been reported, it looks unlikely in our case.

References

1.Pruzan DL, Esterly NB, Prose NS. Eruptive Syringoma. Arch Dermatol 1989;125:1119-20.  Back to cited text no. 1  [PUBMED]  
2.Patrizi A, Neri I, Marzaduri S, Varotti E, Passarini B. Syringoma: A review of twenty-nine cases. Acta Derm Venereol 1998;78:460-2.  Back to cited text no. 2    
3.Gómez MI, Pιrez B, Azaρa JM, Nunez M, Ledo A. Eruptive syringoma: treatment with topical tretinoin. Dermatology 1994;189:105-6.  Back to cited text no. 3    
4.McCalmont TH. Adnexal neoplasms. In : Bolognia JL, Jorizzo JL, Rapini RP, editors. Dermatology. Mosby Co: USA; 2003. p. 1733-55.  Back to cited text no. 4    
5.Kuttner BJ, Kaplan DL, Rothstein MS. Eruptive pruritic papules. Arch Dermatol 1989;125:985-90.   Back to cited text no. 5    
6.Casas AP, Gαrcia-Dνez A. Eruptive pruritic syringomas: Treatment with topical atropine. J Am Acad Dermatol 2001;44:148-9.  Back to cited text no. 6    

Copyright 2006 - Indian Journal of Dermatology, Venereology and Leprology


The following images related to this document are available:

Photo images

[dv06085f1.jpg] [dv06085f3.jpg] [dv06085f2.jpg]
Home Faq Resources Email Bioline
© Bioline International, 1989 - 2024, Site last up-dated on 01-Sep-2022.
Site created and maintained by the Reference Center on Environmental Information, CRIA, Brazil
System hosted by the Google Cloud Platform, GCP, Brazil