Luciano Schiazza M.D.
Syringoma is a benign adnexal tumor derived from the intraepidermal portion of the eccrine sweat ducts. It occurs more frequently among women. Although occasionally solitary, they usually are multiple, in great numbers: widespread distribution is typical of eruptive syringoma, first described by Jacquet and Darier in 1887. The name syringoma is derived from the Greek syrinx, which means pipe or tube.
Eruptive syringoma consists of small firm skin coloured or slight yellow or erythematous flat-topped papules 1-2 mm in diameter: they usually present in large numbers in successive crops on the chest, in a bilateral, symmetrical distribution.
Syringomas are asymptomatic. In rare cases they have been associated with pruritus, especially in the setting of perspiration.
Histologically, syringomas demonstrate distinctive features. A normal epidermis overlies a dermis where, embedded in a fibrous, sclerotic stroma, are numerous small ducts, the wall of which are lined usually by two rows of cuboidal-to-flattened epithelial cells. The lumina of the ducts contains periodic acid-Schiff-positive amorphous debris.
Some ducts have elongated tails of epithelial cells, producing a characteristic comma-shaped or tadpole appearance.
Clinically syringomas may mistaken for acne vulgaris, sebaceous hyperplasia, milia, lichen planus, eruptive xanthoma, urticaria pigmentosa, hidrocystoma, trichoepithelioma, disseminated granuloma annulare, steatocystoma multiplex, apocrine hidrocistoma, Fox-Fordyce disease.
Treatment of syringomas is cosmetic only. But since these lesions are located in the dermis and often numerous, there is no standard treatment. Possible treatments include: liquid nitrogen crytherapy, electrocautery, dermabrasion, oral isotretinoin, topical tretinoin, lasers. Unfortunately treatment may end in an insignificant efficacy and is generally unsatisfactory and frustrating.