Journal of Pakistan Association of Dermatologists 2012;22:153-156.

Case Report

Generalized eruptive syringoma

Shahid Hassan*, Nuzhat Rizvi**, Masuma P Bhengra*, Shyam S Chaudhary*
*Department of Dermatology, Venereology and Leprosy, Rajendra Institute of Medical Sciences,
Ranchi, India
**Department of Obs & Gynecology, Darbhanga Medical College, Darbhanga, Bihar, India

Abstract

Syringoma is a benign adnexal neoplasm formed by well-differentiated ductal elements. The name
syringoma is derived from Greek word Syrinx which means pipe or tube. Most commonly,
syringomas are skin-colored or yellowish, small dermal rounded or flat papules ranging from 13mm in diameter in the lower lid and upper part of the cheek. Eruptive syringoma is clinically
distinct, uncommon variant of syringomas. Since the initial description by Darier and Jaquet in
1887, less than 100 cases have been reported to date. A case of 18 year old female with a 5 year
history of eruptive syringoma is presented.
Key words
Generalized eruptive syringoma, eccrine ducts, papules.

Introduction
Syringomas are benign appendageal tumors of
intraepidermal eccrine sweat ducts. In eruptive
syringoma, a rare variant first described by
Jacquet and Darier in 1887, the lesions
occurred in successive crops on the anterior
chest, neck, upper abdomen, axilla and the
periumbilical region at puberty or during
childhood.1 It occurs more frequently among
women.2,3 The lesion consists of asymptomatic
multiple small firm yellow brown colored
papules that typically presents in a bilateral
symmetrical distribution.4 The lesions are
benign and may spontaneously resolve or
remain stationary throughout life. Treatment of
this benign condition is cosmetic only.5
Case report
A 18-year-old female presented with multiple,
asymptomatic skin lesion of 5 year duration.
Lesion appeared on the forearm first, which
was followed by successive eruption on the
Address for correspondence
Dr. Shahid Hassan
Room No. 21, Hostel No. 4
RIMS, Ranchi, Jharkhand
Phone no 9431268820
E-mail: snrhassan@gmail.com

forearm (Figure 1, figure-2), arm (Figure 3),

upper back, thigh and leg (Figure 4),
respectively. The patient denied any
involvement of mucous membrane and
palmoplantar region. The patient also denied
any other medical problems or the use of over
the counter preparations. There was no one in
the family who was similarly affected. There
was no spontaneous resolution in the period of
observation.
Physical examination revealed multiple, skin
to tan colored, flat-topped papules, 1-3 mm in
diameter, on the forearm, arm thigh, upper
back, leg. The lesions were bilateral,
symmetrical and had both follicular and non
follicular distribution.
A skin biopsy was obtained from a lesion in
the forearm. Punch biopsy specimen revealed
an epithelial neoplasm involving the upper
reticular dermis made up of solid epithelial
islands and ductal structured. The ductal
structures were lined by two or three layers of
cuboidal cells. The same cells present within
solid cords showed attempt towards ductal
differentiation. The stroma was made up of
thickened bundle of collagen (Figures 5 and
6).

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Figure 1 Flat-topped papules on right forearm.

Figure 4 Disseminated lesions of syringoma on leg.

Figure 2 Multiple plane-topped papules on right

forearm.

Figure 5 10x zoom showing epithelial neoplasm

involving upper reticular dermis-solid epithelial
island and ductal element.

Figure 6 40x zoom showing ductal structure lined

by two or three layers of cuboidal cells.

With the histologic evidence and clinical

history and appearance a diagnosis of eruptive
syringoma was made.
Figure 3 Similar flat-topped papules on lateral side
of right arm.

Discussion
Syringoma are benign tumors arising from the
intraepidermal portion of sweat ducts and
affect about 0.6% of the general population,

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occurring more frequently in women during

puberty.2,3
Initial description was given by Kaposi in
1872,[6] later on in 1887 Jacquet and Darier
described the eruptive form.7
Friedman and Butler proposed a classification
based on the clinical features and association.8
This consists of four principal clinical variants
of syringoma, a localized form, a familial
form, a form associated with Downs
syndrome and a generalized form that
encompasses
multiple
and
eruptive
syringoma.10,12 Clinically , this presentation is
characterized by multiple papular skin-colored
or slightly pigmented lesions. These may be
located on face, neck, trunk, abdomen, limbs
sparing the palmoplantar region and mucosa,
as seen in our patient.9,10 The diagnosis is by
histopathological examination.
Recent studies suggest that eruptive syringoma
is not a true neoplasm but a reactive process in
hyperplastic eccrine duct, resulting from a
previous cutaneous inflammation,2,10,11 although
the pathophysiology of eruptive syringoma is
not yet completely understood.
There are also reports in literature on the
association of eruptive syringoma in Downs
syndrome,12,13 diabetes,14 milium,15 sarcoidosis,
elevated serum carcinoembryonic antigen
(CEA)16 and psychiatric disorders.17
Treatment of syringomas is cosmetic. Options
are abundant and generally unsatisfactory.
Physical techniques such as excision,
electrocoagulation and liquid nitrogen,
cryotherapy and dermabrasion yield poor
cosmetic results.3,18 Oral isotretinoin and
topical tretinoin and adapalene have been used
as well as ablative techniques such as the CO2
laser with variable success.

Most of the literature suggests using CO2

laser.19 One study demonstrates good results
with temporary tattooing following Qswitched alexandrite laser.20
Unfortunately, all surgical intervention results
in scarring. A recent report suggests the use of
topical atropine to alleviate the pruritus in
symptomatic eruptive syringoma.10
Our case received no treatment and the clinical
condition remained unchanged during 8 month
of follow up period.
References
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