An unusual presentation and distribution of generalized eruptive syringomas.

A 19-year-old Caucasian man presented with numerous erythematous to flesh-colored papules that appeared in crops on his neck, axillae, buttocks, and lower back. The lesions started on his anterior neck at age 12. At 18 years, new crops of papules appeared on his axillae, back, and buttocks over several months. He reported pruritus in the lesions following exercise and perspiration. He denied any family history of similar lesions. His primary care physician treated him with topical triamcinolone 0.1% cream, which made the lesions smaller, less erythematous, and less pruritic; however, the papules never fully resolved. After discontinuation of the steroids, these erythematous pruritic papules gradually recurred in the same areas of his body. The patient denied any other medical complaints.

Botulinum toxin A as monotherapy for syringoma.

Syringoma is a benign adnexal tumor of the skin originating from the eccrine sweat duct. There is a wide variety of treatments, and most of the patients receive multiple unsuccessful therapies. The goal of this report intends to describe a novel technique applicable to syringoma with botulinum toxin A. A 61-year-old female patient with localized syringomas in the periocular and upper lip region, with a long-lasting history, treated with botulinum toxin A 46 IU as monotherapy intradermally distributed and a follow-up for 8 months. Our patient displayed a significant improvement of the syringomas. Botulinum toxin A is an efficient and safe technique to treat syringomas.

A case report of postpubertal eruptive syringoma triggered with antiepileptic drugs.

Eruptive syringoma is a rare variant of syringoma, which typically occurs in large numbers as multiple yellow-brown colored papules. It usually presents before or during puberty. The pathogenesis of eruptive syringoma is unclear. It could represent a hyperplastic response of the eccrine ducts to an inflammatory reaction caused by an unknown trigger. The association between drugs and eruptive syringoma has not been reported in the literature until now. A 34-year-old woman with multiple asymptomatic papular eruptions of nine years' duration visited the authors' outpatient clinic. She had been using antiepileptic drugs for epilepsy for 10 years. Dermatological examination revealed multiple skin-colored to brownish papules, 1-3 mm in diameter, on the trunk and neck. Skin biopsy was performed from a lesion on the neck. According to clinical and histopathological findings, the patient was diagnosed as having eruptive syringoma. This case is very interesting, because the patient had been using antiepileptic drugs for a long time and the onset of her lesions was in postpubertal period. The authors' hypothesize that her lesions occured due to antiepileptics which may be a trigger of syringomatous proliferation. The authors conclude that drugs, especially antiepileptics, should be kept in mind in reference to the etiology of eruptive syringomas.

A new treatment for syringoma. Combination of carbon dioxide laser and trichloroacetic acid.

BACKGROUND: Although syringoma represents a benign tumor of skin appendage, multiple and diffuse facial lesions can cause cosmetic problems for the affected individuals. Scarring, recurrence and postinflammatory hyperpigmentation can be serious troubles, especially for oriental people receiving various therapeutic modalities. OBJECTIVE: The purpose of this study was to evaluate the histopathologic and clinical efficacy of a new therapeutic approach for syringoma, consisting of combination of carbon dioxide (CO2) laser and 50% trichloroacetic acid (TCA). METHODS: Eighty skin biopsy specimens (45 patients) were evaluated to determine the depth of syringoma lesion. Among these, 28 specimens were obtained after a single test-pulse of CO2 laser (focused, superpulsed mode, power setting of 0.7-2 watts, beam diameter of 0.1 mm, pulse duration of 0.1 seconds), and 3 specimens after one pass of CO2 laser and 50% TCA. The depths of laser-induced vaporization and TCA-induced tissue necrosis were measured. Twenty patients were treated with the combination therapy of CO2 laser (two passes of laser) and 50% TCA. Clinical effectiveness and complications of combination therapy were evaluated by direct observation and photographs. RESULTS: Tumor depth: Analysis of eight specimens revealed tumor depth of 0.70 +/- 0.20 mm (mean +/- SD), ranging from 0.4-1.2 mm. There were no correlations between tumor depth and age of onset or duration of the tumor. Laser penetration depth: CO2 laser irradiation, 0.7-2 watts, induced vaporization of 0.29 +/- 0.12 mm in depth with carbonized rim of 0.1 +/- 0.03 mm width (n = 28 from 15 patients). With laser power of 1 watt, vaporization ranged from 0.17-0.45 mm in depth. Laser and TCA induced necrosis: TCA application resulted in extra tissue necrosis of 0.22-0.25 mm in depth beyond the level achieved by laser vaporization. CLINICAL FINDINGS: Among the 20 patients treated with the combination therapy, therapeutic effect for 11 patients was excellent, 6 patients showed good clinical response, and 3 patients were fair. There were no serious complications resulting from this procedure such as infection, scarring or textural change. CONCLUSION: The application of 50% TCA after CO2 laser irradiation was effective for removing deep-seated syringoma cells and for reducing the side effects, especially scarring. To the best of our knowledge, this is the first study introducing the combination of CO2 laser and TCA for removal of syringoma.

Siringomas eruptivos / Eruptive syringomas

Se presentan tres casos de siringomas eruptivos (tipo Jacquet-Darier). En dos de ellos las lesiones aparecieron en brotes sucesivos en la infancia y en el tercero lo hicieron a una edad más tardía. En todos los casos la histología muestra un cuadro característico de siringomas. Se revisan las características clínicas, histopatológicas, diagnósticos diferenciales y tratamiento de una patología poco común en la práctica diaria