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CAMEO
Year : 2006  |  Volume : 51  |  Issue : 1  |  Page : 53-54
Atypical facial eccrine poromatosis - Effective treatment with topical atropine


Department of Dermatology, St. John's Medical College Hospital, Bangalore - 34, India

Correspondence Address:
Elizabeth Jayaseelan
Department of Dermatology, St. John's Medical College Hospital, Bangalore - 34
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.25198

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Keywords: Eccrine Poroma, Poromatosis, Atropine


How to cite this article:
Madhukara J, Jayaseelan E, Correa M. Atypical facial eccrine poromatosis - Effective treatment with topical atropine. Indian J Dermatol 2006;51:53-4

How to cite this URL:
Madhukara J, Jayaseelan E, Correa M. Atypical facial eccrine poromatosis - Effective treatment with topical atropine. Indian J Dermatol [serial online] 2006 [cited 2019 Jul 19];51:53-4. Available from: http://www.e-ijd.org/text.asp?2006/51/1/53/25198



  Case Report Top


A 32 year old female residing in a coastal, humid city of India, presented with history of multiple, dome shaped, skin or pinkish coloured, firm, discrete, smooth surfaced lesions, 2 to 5 mm in size on both the infraorbital regions and malar areas. These lesions were insidous in onset and gradually increased in number over two years. They became prominent during the hot and humid season and decreased in size during cold weather [Figure - 1]. The patient was clinically free from other dermatological or systemic manifestations at the time of presentation. A differential diagnosis of hidrocystoma and syringoma were considered. The most prominent papule was biopsied and sent for histopathological examination. Meanwhile considering the differential diagnosis of hydrocystoma and syringoma the patient was put on 1% atropine sulphate ointment once daily application.

Histopathological examination showed board trabeculae of epithelial cells arising from the epidermis, extending downwards into the dermis and anastamosing with each other. The cells were uniform in size and shape with vesicular to dark nuclei and a moderate amount of eosinophilic cytoplasm. Melanocytes were seen bordering some of the trabeculae. Tumour cells were negative for PAS stain. The connective tissue in between showed a few prominent blood vessels. Based on these findings diagnosis of eccrine poroma was made [Figure - 2].

Following application of 1% atropine, a marked reduction in size of the lesions was observed within a week. The lesions reduced in size to the point of almost clearance even in hot and humid climate. No systemic or local adverse effects of atropine were observed. Following 3 weeks of topical 1% atropine sulphate patient was symptom free for six months. She had a relapse of a few lesions after 6 months; these however, regressed with the same treatment for two weeks [Figure - 3].


  Discussion Top


This particular case involved only the face sparing the palms and soles. The lesions were entirely papular with waxing and waning accordingly to environmental temperature and humidity levels mimicking hidrocystomas.[1]

The mainstay of treatment of eccrine poroma is by surgical excision;[2],[3] however there are reports of successful treatment of solitary lesion with curettage and electrodessication of the base without recurrences.[4] Considering the provisional diagnosis of hidrocystomas patient was started on atropine ointment.[5],[6],[7] The effectiveness of atropine in this particular case can be explained by the fact that eccrine poromas share a common origin with that of eruptive syringomas and hidrocystomas. Some of the tumour cells are known to differentiate towards dermal duct cells. It may be possible that these cells could have got activated during cholenergic stimulation and atropine would have antagonized the above action completely.



 
  References Top

1.Smith JD, Chernoski ME, Houston. Hidrocystomas. Arch Dermatol, 1973; 108: 676-9.  Back to cited text no. 1    
2.Morris J, Margaret MD, Wood G, Samitz MH. Eccrine Poroma. Arch Dermatol, 1968; 98: 162-5.  Back to cited text no. 2    
3.Goldner R, Baltimore. Eccrine Poromatosis. Arch Dermatol, 1970; 101: 606-8.  Back to cited text no. 3    
4.Knox JM, Spiller WF. Eccrine Poroma. Arch Dermatol, 1958; 77: 726-9.  Back to cited text no. 4  [PUBMED]  
5.Clever HW, Sahl WJ. Multiple Eccrine Hidrocystomas a non-surgical treatment. Arch Dermatol, 1991; 127: 422-3.  Back to cited text no. 5  [PUBMED]  
6.Armstrong DKB, Walsh MY, Corbett JR. Multiple Facial Eccrine Hidrocystomas effective topical therapy with atropine. Br. J. Dermatol - 1998: 139: 558-9.  Back to cited text no. 6    
7.Tatiana Sanz Sanchez Esteban Dauden. Eruptive Pruritic Syringomas: Treatment with topical atropine. J. Am Acad Dermatol, 2001; 148.  Back to cited text no. 7    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3]



 

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