Acral Eruptive Syringoma: An Unusual Presentation with Misdi
Syringomas are well known to be benign adnexal tumors detected most commonly in periorbital skin areas of middle-aged women. Eruptive syringoma is a rare variant of syringoma which appears in large numbers as multiple skin-colored or slightly pigmented papules on the anterior chest, neck, upper abdomen, axillae, and periumbilical region before or during puberty. A few number of syringoma cases with predominantly acral distribution have been reported previously. In this paper, we present a rare case of eruptive syringoma localized in dorsal areas of both hands in a 30-year-old woman.

Authors presented a 30-year-old woman with eruptive syringoma of about 15 years duration, who was referred to the dermatology clinic of Alzahra hospital, Isfahan, Iran. Lesions started from the dorsal side of the patient's right hand without presenting other symptoms such as pruritus, burning sensation, inflammation, or erythema. The number of lesions increased following the epilation of the area for several times and no improvement was observed with the use of local corticosteroids. As a result, she stopped the epilation of her dorsal hand area. The patient refused to do a skin biopsy upon the suggestion of a dermatologist.

At the age of 26 the patient was visited by an expert dermatologist with complaints about the expansion of the lesions to the dorsal areas of her left hand and underwent trichloroacetic acid (TCA) therapy twice with one year gap with suspicion of plane warts. Physical examinations in our clinic showed multiple erythematous, flat-topped papules located on dorsal areas of her hands varying from 1 to 3?mm in size.

Lesions were symmetrical, and Darier's sign was negative. The family history was unremarkable, and there was no previous history of skin disorders. Laboratory test results were normal, and the patient underwent biopsy of skin lesions. Finally, the diagnosis of eruptive syringoma was made based on both clinical and histological findings. In histological sections, multiple nests of cells were seen with pale cytoplasm positioned within sclerotic stroma. Many nests show central ductal differentiation with a compact eosinophilic cuticle. The epidermis is normal; however, numerous tubular structures are embedded in a dense stroma in dermis, and ducts are lined by two rows of epithelial cells. Some of them have comma-like tails (tadpoles).

After establishing the diagnosis, we recommended her some destructive modalities like cautery or radiofrequency for treating these disfiguring lesions, but the patient refused to undergo any treatment.