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CASE REPORT
Year : 2019  |  Volume : 3  |  Issue : 2  |  Page : 148-150

Eruptive syringoma: A rare case report


Department of Dermatology, SMS Medical College and Hospital, Jaipur, Rajasthan, India

Date of Web Publication15-Jul-2019

Correspondence Address:
Shilpi Sharma
Charak Bhavan SMS Medical College, Jaipur - 302 004, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CDR.CDR_20_18

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  Abstract 


Syringoma is a benign adnexal tumor of intraepidermal portion of the eccrine sweat ducts. Eruptive syringoma is a rare clinical variant characterized by small, flesh-colored papules with both follicular and nonfollicular distribution that occur in successive crops on the anterior body surface. We report a case of 35-year-old female with familial eruptive syringoma with predominant acral distribution. We report this case because of the rarity of disorder and acral predominance.

Keywords: Acral, eruptive, familial, syringoma


How to cite this article:
Sharma S, Mathur DK, Paliwal V, Bhargava P. Eruptive syringoma: A rare case report. Clin Dermatol Rev 2019;3:148-50

How to cite this URL:
Sharma S, Mathur DK, Paliwal V, Bhargava P. Eruptive syringoma: A rare case report. Clin Dermatol Rev [serial online] 2019 [cited 2019 Aug 23];3:148-50. Available from: http://www.cdriadvlkn.org/text.asp?2019/3/2/148/262774




  Introduction Top


Syringoma is a benign adnexal tumor of eccrine origin that is commonly seen in females[1] and id the most common on the eyelids.[2] Based on Friedman and Butler's classification scheme, various variants of syringoma are recognized: eruptive, linear, familial, vulvar, penile, scalp, acral, and plaque-type syringomas.[2],[3] Familial eruptive syringoma is a very rare clinical entity with only few reports in world literature. We report a case of familial eruptive syringoma with predominant acral involvement.


  Case Report Top


A 35-year-old female presented to the skin outpatient department with asymptomatic multiple discrete skin-colored to reddish-brown papular lesions over the face, upper chest, abdomen, upper back, both forearms, and dorsum of hands for 8 years. Initially, she noticed these lesions over the extensor aspect of both forearms and dorsum of hands which gradually over a period of 5–6 years increased in number and size to involve most part of the forearm and dorsum of hands. In the past 2–3 years, the lesions progressed rapidly to involve the face, upper chest, upper back, and abdomen. No significant history was obtained regarding any drug intake or systemic disease. Her 18-year-old daughter had similar lesions over the lower eyelids and dorsum of both hands. There was no history of consanguinity.

On examination, multiple discrete skin-colored to reddish-brown flat-topped-to-rounded papules of size ranging from 1 to 4 mm present over the extensor and flexor aspect of both forearms, dorsum of hands, around the eyelids, forehead, temporal region, upper chest, upper back, and abdomen [Figure 1], [Figure 2], [Figure 3]. No changes were observed in hair, nail, and oral mucosa. General physical and systemic examination was unremarkable. Skin biopsy obtained from a lesion in the forearm revealed a normal epidermis, with dermis containing several small ducts embedded in a fibrous stroma. The walls of the ducts are lined by two rows of epithelial cells. Few ducts had comma-like tail of epithelial cells giving it the appearance of tadpole. Ductal lumina were filled with an amorphous material [Figure 4]. On the basis of clinical findings and laboratory investigations, the diagnosis of eruptive syringoma was made.
Figure 1: Syringoma over face

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Figure 2: Syringoma over extensor aspect of forearm and dorsum of hands

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Figure 3: Syringoma over flexor aspect of forearm

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Figure 4: Numerous, scattered, dermal, small ducts lined by two rows of epithelial cells; some of which have epithelial cords with comma-like tails embedded in a sclerotic stroma (H and E, ×100)

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  Discussion Top


Syringoma is a benign adnexal tumor that derives from the intraepidermal portion of the eccrine sweat ducts. They are more frequent in women and tend to occur during puberty or the third or fourth decade.[2]

Friedman and Butler proposed a classification, based on the clinical features and associations. This consisted of four principal clinical variants of syringoma: localized form, familial form, form associated with Down's syndrome, and generalized form that encompasses multiple and eruptive syringoma.[2]

Eruptive syringoma is a rare variant first described by Jacquet and Darier in 1887.[3] It is characterized by small, flesh-colored papules that occur in successive crops on the anterior body surface particularly over the anterior chest, neck, upper abdomen, axillae, and periumbilical region.[4] The lesions are bilateral, symmetrical, and have both follicular and nonfollicular distribution. They are described more frequently in patients with Down's syndrome and Ehlers–Danlos syndrome.[5]

Acral syringoma is also a rare clinical variant[6],[7] characterized by the symmetrical involvement of the dorsal aspect of the hands, feet, fingers, and toes, unassociated with the similar involvement of rest of her body.[7],[8]

Our case was unusual because it shares features of both acral and eruptive syringoma. The lesions were predominantly acral affecting both flexor and extensor surfaces of both forearms and dorsum of hands resembling acral syringoma along with facial and truncal involvement which is seen in eruptive syringoma.

There is no satisfactory treatment for widespread syringoma. Treatment modalities include dermabrasion, various methods of excision, cryosurgery, electrodesiccation, chemical peeling, and oral and topical retinoids.[9]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Seirafi HH, Akhyani M, Naraghi ZS, Mansoori P, Dehkordi HS, Taheri A, et al. Eruptive syringomas. Dermatol Online J 2005;11:13.  Back to cited text no. 1
    
2.
Friedman SJ, Butler DF. Syringoma presenting as milia. J Am Acad Dermatol 1987;16:310-4.  Back to cited text no. 2
    
3.
Jacquet L, Darier J. Hiydradιnomes ιruptifs, ιpithιliomes adιnoides des glandes sudoripares ou adιnomes sudoripares. Ann Dermatol Syph 1887;8:317-23.  Back to cited text no. 3
    
4.
Teixeira M, Ferreira M, Machado S, Alves R, Selores M. Eruptive syringomas. Dermatol Online J 2005;11:34.  Back to cited text no. 4
    
5.
Jamalipour M, Heidarpour M, Rajabi P. Generalized eruptive syringomas. Indian J Dermatol 2009;54:65-7.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Hughes PS, Apisarnthanarax P. Acral syringoma. Arch Dermatol 1977;113:1435-6.  Back to cited text no. 6
    
7.
Koh MJ. Multiple acral syringomas involving the hands. Clin Exp Dermatol 2009;34:e438.  Back to cited text no. 7
    
8.
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. 8
    
9.
Frazier CC, Camacho AP, Cockerell CJ. The treatment of eruptive syringomas in an African American patient with a combination of trichloroacetic acid and CO2 laser destruction. Dermatol Surg 2001;27:489-92.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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