Indian Journal of Dermatology
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CORRESPONDENCE COLUMN
Year : 2005  |  Volume : 50  |  Issue : 3  |  Page : 171-172
Multiple syringomas of the forehead and scalp: An unusual presentation


Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh -160 012, India

Correspondence Address:
M Sendhil Kumaran
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh -160 012
India
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How to cite this article:
Kumaran M S, Kanwar A. Multiple syringomas of the forehead and scalp: An unusual presentation. Indian J Dermatol 2005;50:171-2

How to cite this URL:
Kumaran M S, Kanwar A. Multiple syringomas of the forehead and scalp: An unusual presentation. Indian J Dermatol [serial online] 2005 [cited 2020 Aug 10];50:171-2. Available from: http://www.e-ijd.org/text.asp?2005/50/3/171/18938


Syringomas are benign adnexal tumors of eccrine origin, seen commonly in females, occurring symmetrically over the infraorbital areas. They may also be present over the cheeks, abdomen, axillae, genitals, scalp. forehead and hands. In this report, we describe a case of multiple syringomas of the forehead and scalp, an unusual presentation of this common adnexal tumor.

A 55-year-old man presented with a 6-month history of brown colored, asymptomatic papules that initially appeared over the infraorbital areas followed by forehead and scalp. The patient was disturbed due to the rapid progression of the lesions and of cosmetic concern. There were no systemic complaints or family history of similar lesions. Clinical examination revealed, numerous, discrete, 1-2mm, irregular brown colored papules located over the above mentioned sites. Patient also had androgenetic alopecia. On the scalp, the papular lesions were distributed over the bald as well as hairy areas and were not associated with any loss of hair. Examination of the other body parts was nomal [Figure - 1]. Diagnosis of syringoma was made and biopsy taken from one of the lesion, showed ducts lined by two rows of flattened epithelial cells filled with homogenous, eosinophilic material embedded in a fibrillary stroma. These findings were consistent with syringoma.

The diagnosis of syringoma is most often entertained when a patient present with multiple, small, flesh colored to yellow papules occurring over the infraorbital areas. Rarely they may be localized to uncommon sites such as scalp,[1] forehead,[2],[3] abdomen,[4] genital[4] and moustache area[5]. Friedman, et al[6] classified syringomas based on clinical characteristics and associations. Eruptive syringoma is a rare clinical variant with only few reports in world literature. characterized by papular lesions that usually appear in crops over the neck, chest, axillae, anticubital fossae, upper extremities, abdomen and groin. Recently the term eruptive syringoma is termed a misnomer. Authors claimed that it was a hyperplastic response of the eccrine duct to an inflammatory reaction rather than a true adnexal tumor and proposed the term "syringornatous dermatitis".

Other variants described in the literature are, unilateral eruption,[8] unilateral eruption with linear nevoid distribution,[9] lichen planus type,[10] milia type[6] and urticaria pigmentosa[11].

Histologically, syringomas consist of dermal tumors, with epidermal cysts, cord without lumens and ductile comma like structures lined by 2 rows of epithelial cells.[3] Histologically and immunochemical studies using monoclonal antibodies against keratin, carcinoem-bryonic antigen (CEA),[13] S-100,[14] and other antigens support the theory that syringomas result from abnormal eccrine ductal differentiation. There is no satisfactory treatment for wide spread syringomas, and surgical or chemical destruction involves some risk of scarring. Although carbon dioxide lasers, topical tretinoin, trichloroacetic acid and dermabrasion have been found to be useful, none eliminates the possibility of recurrence. Syringoma may also undergo spontaneous regression with age.

Our patient had numerous syringomas distributed over scalp, forehead and infraorbital areas. Till date, to the best of our knowledge there is only two reports of multiple syringomas localized to forehead.[2],[3] There have been reports of sub-clinical syringomas leading to diffuse hair loss. However, no such hair loss was seen in our patient even though lesions were clinically evident. Although there are only few areas in human skin devoid of cecrine glands. It would not be surprising to see future reports of syringomas arising from areas where eccrine glands are located.[15]



 
   References Top

1.Shelley WB, Wood M. Occult syringomas of scalp associated with progressive hair loss. Arch Dermatol 1980; 116:843- 4.   Back to cited text no. 1    
2. Hempstead RW, Hobbs ER, Howard WR. Numerous syringomas of the forehead. Int J Dermatol 1983;92:485-6.  Back to cited text no. 2    
3.Kim SJ, Ahn SK, Choi EH, Lee SH. Unusual cases of syringomas of the forehead. J Dermatol 1996; 23: 61-4.  Back to cited text no. 3    
4.Lever WE. Schaumberg Lever G. Histopathology of the skin. Eighth Ed. Philadelphia: JB Lippincott, P 778-9.  Back to cited text no. 4    
5.Nguyen DB, Patterson JW, Wilson BB. Syringoma of the moustache area. J Am Acad Dermatol 2003;49:337-9.  Back to cited text no. 5    
6.Friedrnan SI, Buttler DL. Syringoma presenting as milia. J Am Acad Dermatol 1987;16:310-14.  Back to cited text no. 6    
7.Guitart J, Rosenbaum MM, Requena L. Eruptive syringoma a misnomer for a reactive eccrine gland ductal proliferation? J Cutan Pathol 2003; 30: 202-5.  Back to cited text no. 7    
8.Wilms NA, Douglas MC. An unusual case of preponderantly right-sided syringomas. Arch Dermatol 1981;117:308.  Back to cited text no. 8    
9.Yung CW, Soltani K, Bernstein JE, et al . Unilateral linear nevoid syringoma. J Am Acad Dermatol 1981; 4:412-6.   Back to cited text no. 9    
10.Zalla JA, Perry HO. An unusual case of syringoma. Arch Dermatol 1971; 103:494-6.  Back to cited text no. 10    
11.Seifert HW. Multiple Syringome mit vermebrung von Mastzellen unter dem klinischen Bild einer urticaria pigmentosa. Z Haut Kr 1981;56:303-6.  Back to cited text no. 11    
12.Mehregan AH. The origin of the adnexal tumors of the skin:a view point. J Cutan Pathol 1985;12:459-67.  Back to cited text no. 12    
13.Pennevs NS, Nadgi M, Morales A. Carcinoembryonic antigen in benign sweat gland tumors. Arch Dermatol 1982;118:225-7.  Back to cited text no. 13    
14.Kanitakis J, Zambruno G, Viac J, et al. Expression of neural tissue markers (S-100 protein and Leu-7 antigen) by sweat gland tumors of the skin. J Am Acad Dermatol 1987; 17:187-91.  Back to cited text no. 14    
15.Wang JI, Roenigk HHJr. Treatment of multiple facial syringoma with carbon dioxide (CO2) laser. Dermatol Surg 1999;25:135-9.  Back to cited text no. 15    


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