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Year : 2015  |  Volume : 6  |  Issue : 5  |  Page : 376-377  

Axillary syringomas mimicking Fox–Fordyce disease


Department of Dermatology, St. John's Medical College, Rajiv Gandhi university of health sciences, Bengaluru, Karnataka, India

Date of Web Publication4-Sep-2015

Correspondence Address:
Gillian Roga
Department of Dermatology, St. John's Medical College, Bengaluru - 560 034, Karnataka
India
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Source of Support: Nil, Conflict of Interest: None declared.


DOI: 10.4103/2229-5178.164476

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How to cite this article:
Roga G, Bhat I. Axillary syringomas mimicking Fox–Fordyce disease. Indian Dermatol Online J 2015;6:376-7

How to cite this URL:
Roga G, Bhat I. Axillary syringomas mimicking Fox–Fordyce disease. Indian Dermatol Online J [serial online] 2015 [cited 2019 Dec 7];6:376-7. Available from: http://www.idoj.in/text.asp?2015/6/5/376/164476

A 25-year-old boy presented with 6 years history of asymptomatic papules over both axillae [Figure 1] and neck [Figure 2], and the development of similar papules around the eyes [Figure 3]. Physical examination revealed multiple, 1–2 mm in size, hyperpigmented, well-defined, oval to round papules over both axillae. There were similar papules on the flexor aspect of the neck, infraorbital area and trunk.
Figure 1: Axillary papules

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Figure 2: Papules in beard region

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Figure 3: Infraorbital papules

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Our differential diagnosis at this point of time was syringoma and Fox–Fordyce disease. A punch biopsy was performed. The histopathological findings of the papule on biopsy showed the dermis containing numerous ducts embedded in fibrous connective tissue stroma. The walls of the duct were lined by cuboidal to flattened epithelium, with a few containing eosinophilic material in their lumen. Some of the ducts had a comma shaped appearance [Figure 4] and [Figure 5]. These clinical findings were consistent with syringoma.
Figure 4: H and E, ×10

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Figure 5: H and E, ×40

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Syringoma is derived from the Greek word "syrnx," which means pipe or tube. It is a benign adnexal tumor derived from epidermal eccrine ducts. Recent studies suggest that the lower acrosyringium or the transitional portion between the acrosyringium and the dermal duct as the point of origin.[1],[2] The classification criteria of syringoma proposed by Friedman and Butler lists four variants:[3] Localized form, familial form, a form associated with Down's syndrome and a generalized form. Generalized syringoma has an earlier onset than localized syringoma. A rare variant, eruptive syringoma, described by Jacquet and Darier in 1987, occur in large numbers, in crops on the anterior chest, neck, upper abdomen, axillae, and the periumbilical region at puberty or during childhood among women. Eruptive syringoma is commonly seen in patients with Down's syndrome and Ehler–Danlos syndrome.[4]

Syringomas are usually located in the head and neck region, especially periorbitally.[5] They are less common on the scalp, forehead, cheeks, abdomen, extremities, axilla[6], genitalia and buttocks.[7] They clinically present as small, firm, skin-colored, yellow or brown papules.[8] Most studies, show a female to male ratio of 2:1, although some show a ratio as high as 6.6:1.[9],[10] They occur mostly during puberty or during the third and fourth decades of life.[2]

Differential diagnoses for axillary syringoma are Darier's disease, Fox–Fordyce disease, Hailey–Hailey disease, plane warts, and keratosis pilaris.[11]

There is no permanent treatment for widespread syringomas, and surgical or chemical destruction involves some risk of scarring. Carbon dioxide lasers, topical tretinoin, trichloroacetic acid and dermabrasion have been found to be useful.[12]

 
   References Top

1.
Eckert F, Nilles M, Schmid U, Altmannsberger M. Distribution of cytokeratin polypeptides in syringomas. An immunohistochemical study on paraffin-embedded material. Am J Dermatopathol 1992;14:115-21.  Back to cited text no. 1
    
2.
Ohnishi T, Watanabe S. Immunohistochemical analysis of keratin expression in clear cell syringoma. A comparative study with conventional syringoma. J Cutan Pathol 1997;24:370-6.  Back to cited text no. 2
    
3.
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. 3
    
4.
Jacquet L, Darrier J. Hiydradinomes iruptifs, ipithiliomes adinoides des glandes sudoripares ou adinomes sudoripares. Ann Dermatol Syphiligr 1887;8:317-23.  Back to cited text no. 4
    
5.
Shelley WB, Wood MG. Occult syringomas of scalp associated with progressive hair loss. Arch Dermatol 1980;116:843-4.  Back to cited text no. 5
[PUBMED]    
6.
Heo YS, Oh TS, Oh CH, Song HJ. A case of axillar syringomas. Ann Dermatol 2010;22:85-7.  Back to cited text no. 6
    
7.
Nguyen DB, Patterson JW, Wilson BB. Syringoma of the moustache area. J Am Acad Dermatol 2003;49:337-9.  Back to cited text no. 7
    
8.
Bal N, Aslan E, Kayaselcuk F, Tarim E, Tuncer I. Vulvar syringoma aggravated by pregnancy. Pathol Oncol Res 2003;9:196-7  Back to cited text no. 8
    
9.
Weiss E, Paez E, Greenberg AS, San Juan E, Fundaminsky M, Helfman TA. Eruptive syringomas associated with milia. Int J Dermatol 1995;34:193-5.  Back to cited text no. 9
    
10.
Lee JH, Chang JY, Lee KH. Syringoma: A clinicopathologic and immunohistologic study and results of treatment. Yonsei Med J 2007;48:35-40.  Back to cited text no. 10
    
11.
Kakinuma H, Urahashi J. Multiple axillary papules. Arch Dermatol 2004;140:1161-6.  Back to cited text no. 11
    
12.
Wang JI, Roenigk HH Jr. Treatment of multiple facial syringomas with the carbon dioxide (CO2) laser. Dermatol Surg 1999;25:136-9.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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