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Multiple Axillary Papules—Diagnosis

Multiple Axillary Papules—Diagnosis Diagnosis: Axillary syringoma. Microscopic findings The biopsy specimen of a papule showed multiple ductal and small cystic structures embedded in a fibrous connective tissue stroma in the dermis. The ducts were lined by 1 or 2 rows of epithelial cells (Figure 2). These histopathologic findings were consistent with syringoma. Figure 2. View LargeDownload Discussion Syringoma is a relatively common appendageal tumor showing eccrine acrosyringeal differentiation. The typical clinical appearance of syringoma is firm, with skin-colored to brown papules on the lower eyelids.1 Some clinical variants (eruptive,2 linear,3 familial,4 vulvar,5 penile,6 scalp,7 and acral8 syringomas), as well as a histologic variant (clear cell syringoma), have been described. Although the axilla is a well-described site for syringoma, no previous case of syringoma limited to the axillae has been reported in the literature. In the 12 reported cases of eruptive syringoma,9 axillary involvement was seen in only 3 patients. Clinical diagnosis is not difficult in cases in which the location of the syringoma is typical. However, in cases without typical facial involvement, the diagnosis is likely to depend on histologic findings. Axillary syringoma should be differentiated from other diseases that present with brown papular lesions in the axillae, such as Darier disease, Fox-Fordyce disease, and Hailey-Hailey disease. Flat warts and keratosis pilaris may also be considered in the differential diagnosis because of their similar morphological features. In Darier disease, other parts of the body, ie, the so-called seborrheic areas, such as the upper chest area, back, ears, nasolabial folds, forehead, scalp, and groin, are simultaneously affected. The lesions of Darier disease, which are frequently itchy and sometimes painful, consist of greasy, scaly, or crusted, keratotic, yellow to brown papules. They may be exacerbated by stress, heat, sweating, or maceration. Some lesions may be associated with hair follicles, and nail changes are characteristic of this disease. There is no optimal treatment for syringoma. Cosmetic considerations are generally the only reason to treat syringoma. Surgical and chemical destructive treatments carry the risks of scarring, postinflammatory pigmentary changes, and recurrence. Oral retinoid (isotretinoin) therapy has been reported to have no effect on the course or status of syringoma.9 Some authors suggest that elastic fibers may play a role in promoting sweat duct proliferation and dilatation. Regression of the lesions in adulthood may occur.5 Article Submissions Clinicians, local and regional societies, and residents and fellows in dermatology are invited to submit quiz cases to this section. Cases should follow the established pattern and be submitted double-spaced. Photomicrographs and illustrations must be clear and submitted as 3 positive color transparencies and as 3 color prints. Material should be accompanied by the required copyright transfer statement, as noted in "Instructions for Authors." Material for this section should be submitted to Michael E. Ming, MD, Department of Dermatology, University of Pennsylvania Health System, 2 Maloney Bldg, 3600 Spruce St, Philadelphia, PA 19104-4283. Reprints are not available from the authors. Dr Kakinuma died before the publication of this article. References 1. MacKie RM Syringoma Champion RHOedBurton JLedBurns DAedBreathnach SMed Textbook of Dermatology. Vol 26th ed. Oxford, England Blackwell Scientific Publications1992;1712- 1713Google Scholar 2. Pruzan DEsterly NProse NS Eruptive syringoma Arch Dermatol. 1989;1251119- 1120PubMedGoogle ScholarCrossref 3. Yung CWSoltani KBernstein JELorinz AL Unilateral linear nevoidal syringoma J Am Acad Dermatol. 1981;4412- 416PubMedGoogle ScholarCrossref 4. Thomas JMajmudar BGorelkin L Syringoma localized to the vulva Arch Dermatol. 1979;11595- 96PubMedGoogle ScholarCrossref 5. Hashimoto KBlum DFukaya TEto H Familiar syringoma: case history and application of monoclonal anti–eccrine gland antibodies Arch Dermatol. 1985;121756- 760PubMedGoogle ScholarCrossref 6. Zalla JAPerry HO An unusual case of syringoma Arch Dermatol. 1971;103215- 217PubMedGoogle ScholarCrossref 7. Pujol RMoreno AGonzalez MJDe Moragas JM Syringoma du cuir chevelu Ann Dermatol Venereol. 1986;113693- 695PubMedGoogle Scholar 8. Hughes PSHApisarnthanarax P Acral syringoma Arch Dermatol. 1977;1131435- 1436PubMedGoogle ScholarCrossref 9. Janniger CKJersey NNBrodkin RHO Eruptive syringoma Cutis. 1990;46247- 249PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Multiple Axillary Papules—Diagnosis

Archives of Dermatology , Volume 140 (9) – Sep 1, 2004

Multiple Axillary Papules—Diagnosis

Abstract

Diagnosis: Axillary syringoma. Microscopic findings The biopsy specimen of a papule showed multiple ductal and small cystic structures embedded in a fibrous connective tissue stroma in the dermis. The ducts were lined by 1 or 2 rows of epithelial cells (Figure 2). These histopathologic findings were consistent with syringoma. Figure 2. View LargeDownload Discussion Syringoma is a relatively common appendageal tumor showing eccrine acrosyringeal differentiation. The typical clinical appearance...
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Publisher
American Medical Association
Copyright
Copyright © 2004 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.140.9.1161-d
Publisher site
See Article on Publisher Site

Abstract

Diagnosis: Axillary syringoma. Microscopic findings The biopsy specimen of a papule showed multiple ductal and small cystic structures embedded in a fibrous connective tissue stroma in the dermis. The ducts were lined by 1 or 2 rows of epithelial cells (Figure 2). These histopathologic findings were consistent with syringoma. Figure 2. View LargeDownload Discussion Syringoma is a relatively common appendageal tumor showing eccrine acrosyringeal differentiation. The typical clinical appearance of syringoma is firm, with skin-colored to brown papules on the lower eyelids.1 Some clinical variants (eruptive,2 linear,3 familial,4 vulvar,5 penile,6 scalp,7 and acral8 syringomas), as well as a histologic variant (clear cell syringoma), have been described. Although the axilla is a well-described site for syringoma, no previous case of syringoma limited to the axillae has been reported in the literature. In the 12 reported cases of eruptive syringoma,9 axillary involvement was seen in only 3 patients. Clinical diagnosis is not difficult in cases in which the location of the syringoma is typical. However, in cases without typical facial involvement, the diagnosis is likely to depend on histologic findings. Axillary syringoma should be differentiated from other diseases that present with brown papular lesions in the axillae, such as Darier disease, Fox-Fordyce disease, and Hailey-Hailey disease. Flat warts and keratosis pilaris may also be considered in the differential diagnosis because of their similar morphological features. In Darier disease, other parts of the body, ie, the so-called seborrheic areas, such as the upper chest area, back, ears, nasolabial folds, forehead, scalp, and groin, are simultaneously affected. The lesions of Darier disease, which are frequently itchy and sometimes painful, consist of greasy, scaly, or crusted, keratotic, yellow to brown papules. They may be exacerbated by stress, heat, sweating, or maceration. Some lesions may be associated with hair follicles, and nail changes are characteristic of this disease. There is no optimal treatment for syringoma. Cosmetic considerations are generally the only reason to treat syringoma. Surgical and chemical destructive treatments carry the risks of scarring, postinflammatory pigmentary changes, and recurrence. Oral retinoid (isotretinoin) therapy has been reported to have no effect on the course or status of syringoma.9 Some authors suggest that elastic fibers may play a role in promoting sweat duct proliferation and dilatation. Regression of the lesions in adulthood may occur.5 Article Submissions Clinicians, local and regional societies, and residents and fellows in dermatology are invited to submit quiz cases to this section. Cases should follow the established pattern and be submitted double-spaced. Photomicrographs and illustrations must be clear and submitted as 3 positive color transparencies and as 3 color prints. Material should be accompanied by the required copyright transfer statement, as noted in "Instructions for Authors." Material for this section should be submitted to Michael E. Ming, MD, Department of Dermatology, University of Pennsylvania Health System, 2 Maloney Bldg, 3600 Spruce St, Philadelphia, PA 19104-4283. Reprints are not available from the authors. Dr Kakinuma died before the publication of this article. References 1. MacKie RM Syringoma Champion RHOedBurton JLedBurns DAedBreathnach SMed Textbook of Dermatology. Vol 26th ed. Oxford, England Blackwell Scientific Publications1992;1712- 1713Google Scholar 2. Pruzan DEsterly NProse NS Eruptive syringoma Arch Dermatol. 1989;1251119- 1120PubMedGoogle ScholarCrossref 3. Yung CWSoltani KBernstein JELorinz AL Unilateral linear nevoidal syringoma J Am Acad Dermatol. 1981;4412- 416PubMedGoogle ScholarCrossref 4. Thomas JMajmudar BGorelkin L Syringoma localized to the vulva Arch Dermatol. 1979;11595- 96PubMedGoogle ScholarCrossref 5. Hashimoto KBlum DFukaya TEto H Familiar syringoma: case history and application of monoclonal anti–eccrine gland antibodies Arch Dermatol. 1985;121756- 760PubMedGoogle ScholarCrossref 6. Zalla JAPerry HO An unusual case of syringoma Arch Dermatol. 1971;103215- 217PubMedGoogle ScholarCrossref 7. Pujol RMoreno AGonzalez MJDe Moragas JM Syringoma du cuir chevelu Ann Dermatol Venereol. 1986;113693- 695PubMedGoogle Scholar 8. Hughes PSHApisarnthanarax P Acral syringoma Arch Dermatol. 1977;1131435- 1436PubMedGoogle ScholarCrossref 9. Janniger CKJersey NNBrodkin RHO Eruptive syringoma Cutis. 1990;46247- 249PubMedGoogle Scholar

Journal

Archives of DermatologyAmerican Medical Association

Published: Sep 1, 2004

Keywords: axilla,papule,syringoma

References