Case for Diagnosis
Recent Onset of Multiple Asymptomatic Brownish Papules
Múltiples pápulas parduzcas asintomáticas de reciente aparición en el tronco
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Quintana-Codina, M.T. Fernández-Figueras, M. Salleras Redonnet" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Quintana-Codina" "email" => array:1 [ 0 => "mquintanacodina@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.T." "apellidos" => "Fernández-Figueras" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Salleras Redonnet" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitari Sagrat Cor, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitari Sagrat Cor, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Múltiples pápulas parduzcas asintomáticas de reciente aparición en el tronco" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 538 "Ancho" => 717 "Tamanyo" => 61289 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Clinical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 34-year-old woman with no personal or family history of interest consulted for multiple asymptomatic lesions on the trunk. The lesions had appeared gradually during the previous year.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed nondesquamative brownish papules measuring 3 to 5  mm in diameter located mainly on the abdomen and also on the thorax, axillas, and pelvis. The lesions were negative for the Darier sign (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Additional Tests</span><p id="par0015" class="elsevierStylePara elsevierViewall">Dermoscopy revealed a homogeneous clear brown area with a delicate pigment network (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">High-frequency ultrasound (18 MHz, MyLab 25Gold, Esaote) revealed well-defined oval lesions in the superficial dermis. These were slightly hypoechogenic with respect to the adjacent dermis and heterogeneous in terms of content (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). Color Doppler did not reveal blood flow in the lesions.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Histology of a punch biopsy specimen of 1 of the lesions revealed scattered ductal structures in the superficial reticular dermis accompanied by slight interstitial mucin deposition and mild sclerosis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">[[?]]What is your diagnosis?</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Generalized eruptive syringoma.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Course and Treatment</span><p id="par0040" class="elsevierStylePara elsevierViewall">The patient was informed about various therapeutic approaches. The initial option was topical tretinoin 0.05%, although little improvement was observed at 6 months. Subsequent alternatives were rejected by the patient.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0045" class="elsevierStylePara elsevierViewall">Syringomas are benign adnexal tumors that originate in the eccrine ducts. They are more common in women and are usually found in clusters on the eyelids. The eruptive variant is rare and normally appears in childhood or puberty.</p><p id="par0050" class="elsevierStylePara elsevierViewall">There are 4 clinical variants of syringoma: localized, generalized, associated with Down syndrome, and familial. The generalized variant comprises 2 clinical forms: multifocal and eruptive. The latter was described by Jacquet and Darier as an eruptive episode of papules on the neck, trunk, axillas, and abdomen. Syringomas generally first appear in childhood and extend over 2-3 years, before becoming persistent. They consist of multiple papules that are usually brown in color and asymptomatic, although in some cases they may prove to be pruriginous.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">There are 3 subtypes of generalized eruptive syringomas: lichen planus–like, urticaria pigmentosa–like, and miliary cyst–like. The differential diagnosis should be mainly with these entities. When they affect the thorax and abdomen, the lesions are usually limited to the anterior surface, with involvement of the back and lower back being exceptional. This characteristic may be of some help in the differential diagnosis of multiple syringomas and urticaria pigmentosa or lichen planus.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Diagnosis is usually based on histopathology. The literature contains only 3 dermatoscopic descriptions of syringoma, whose image varies depending on the subtype.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> Furthermore, ultrasound findings have not previously been reported for this lesion.</p><p id="par0065" class="elsevierStylePara elsevierViewall">There have been reports of isolated cases of syringoma associated with diabetes mellitus and tumor syndromes such as Brooke-Spiegler syndrome, Nicolau-Balus syndrome, and Costello syndrome.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Incel Uysal et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> recently reported a case of adult-onset eruptive syringoma associated with bilateral renal carcinoma.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Treatment is usually ineffective, and there is a risk of recurrence and scarring. Destructive methods have also been used. These include CO<span class="elsevierStyleInf">2</span> laser, dermabrasion, chemical peels, electrocautery, surgical removal, and topical treatment (retinoids and atropine). CO<span class="elsevierStyleInf">2</span> laser is probably the most effective treatment available today, and its adverse effects are acceptable.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In conclusion, we present an uncommon case of adult-onset generalized eruptive syringoma located on the abdomen, thorax, axillas, and pelvis. Given the late age of onset and low degree of clinical suspicion, diagnosis was based on histopathology. We also provide the first description of the ultrasound characteristics of this tumor, although we found no specific defining characteristics that would enable us to distinguish this tumor from other soft tissue tumors. Finally, we wish to highlight the importance of including papular skin conditions at any age in the differential diagnosis of generalized eruptive syringoma.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:3 [ "identificador" => "sec0015" "titulo" => "Additional Tests" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] ] ] 3 => array:2 [ "identificador" => "sec0025" "titulo" => "Course and Treatment" ] 4 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 5 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-05-12" "fechaAceptado" => "2018-06-10" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Quintana-Codina M, Fernández-Figueras MT, Salleras Redonnet M. Múltiples pápulas parduzcas asintomáticas de reciente aparición en el tronco. Actas Dermosifiliogr. 2020;111:157–158.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 538 "Ancho" => 717 "Tamanyo" => 61289 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1047 "Ancho" => 714 "Tamanyo" => 99515 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 589 "Ancho" => 727 "Tamanyo" => 101586 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification, ×25.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation and management of the patient with multiple syringomas: A systematic review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 11 | 25 |
| 2024 October | 69 | 48 | 117 |
| 2024 September | 73 | 32 | 105 |
| 2024 August | 96 | 57 | 153 |
| 2024 July | 70 | 45 | 115 |
| 2024 June | 73 | 38 | 111 |
| 2024 May | 63 | 29 | 92 |
| 2024 April | 59 | 19 | 78 |
| 2024 March | 66 | 29 | 95 |
| 2024 February | 44 | 28 | 72 |
| 2024 January | 52 | 33 | 85 |
| 2023 December | 56 | 15 | 71 |
| 2023 November | 83 | 28 | 111 |
| 2023 October | 79 | 23 | 102 |
| 2023 September | 40 | 30 | 70 |
| 2023 August | 32 | 18 | 50 |
| 2023 July | 44 | 29 | 73 |
| 2023 June | 42 | 16 | 58 |
| 2023 May | 45 | 26 | 71 |
| 2023 April | 23 | 14 | 37 |
| 2023 March | 45 | 22 | 67 |
| 2023 February | 55 | 21 | 76 |
| 2023 January | 38 | 33 | 71 |
| 2022 December | 45 | 46 | 91 |
| 2022 November | 40 | 34 | 74 |
| 2022 October | 30 | 15 | 45 |
| 2022 September | 24 | 26 | 50 |
| 2022 August | 37 | 41 | 78 |
| 2022 July | 29 | 35 | 64 |
| 2022 June | 21 | 22 | 43 |
| 2022 May | 47 | 39 | 86 |
| 2022 April | 50 | 19 | 69 |
| 2022 March | 33 | 37 | 70 |
| 2022 February | 28 | 23 | 51 |
| 2022 January | 27 | 30 | 57 |
| 2021 December | 37 | 43 | 80 |
| 2021 November | 44 | 40 | 84 |
| 2021 October | 30 | 35 | 65 |
| 2021 September | 22 | 36 | 58 |
| 2021 August | 29 | 19 | 48 |
| 2021 July | 22 | 20 | 42 |
| 2021 June | 30 | 18 | 48 |
| 2021 May | 29 | 41 | 70 |
| 2021 April | 74 | 28 | 102 |
| 2021 March | 49 | 27 | 76 |
| 2021 February | 47 | 29 | 76 |
| 2021 January | 31 | 16 | 47 |
| 2020 December | 33 | 17 | 50 |
| 2020 November | 23 | 16 | 39 |
| 2020 October | 30 | 10 | 40 |
| 2020 September | 40 | 14 | 54 |
| 2020 August | 32 | 18 | 50 |
| 2020 July | 30 | 17 | 47 |
| 2020 June | 21 | 21 | 42 |
| 2020 May | 53 | 15 | 68 |
| 2020 April | 60 | 22 | 82 |
| 2020 March | 9 | 7 | 16 |
| 2020 February | 1 | 2 | 3 |
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