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    "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&#46; The lesions had appeared gradually during the previous year&#46;</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&#8239; mm in diameter located mainly on the abdomen and also on the thorax&#44; axillas&#44; and pelvis&#46; The lesions were negative for the Darier sign &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</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 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">High-frequency ultrasound &#40;18&#8239;MHz&#44; MyLab 25Gold&#44; Esaote&#41; revealed well-defined oval lesions in the superficial dermis&#46; These were slightly hypoechogenic with respect to the adjacent dermis and heterogeneous in terms of content &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; Color Doppler did not reveal blood flow in the lesions&#46;</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 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">&#91;&#91;&#63;&#93;&#93;What is your diagnosis&#63;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Generalized eruptive syringoma&#46;</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&#46; The initial option was topical tretinoin 0&#46;05&#37;&#44; although little improvement was observed at 6 months&#46; Subsequent alternatives were rejected by the patient&#46;</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&#46; They are more common in women and are usually found in clusters on the eyelids&#46; The eruptive variant is rare and normally appears in childhood or puberty&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">There are 4 clinical variants of syringoma&#58; localized&#44; generalized&#44; associated with Down syndrome&#44; and familial&#46; The generalized variant comprises 2 clinical forms&#58; multifocal and eruptive&#46; The latter was described by Jacquet and Darier as an eruptive episode of papules on the neck&#44; trunk&#44; axillas&#44; and abdomen&#46; Syringomas generally first appear in childhood and extend over 2-3 years&#44; before becoming persistent&#46; They consist of multiple papules that are usually brown in color and asymptomatic&#44; although in some cases they may prove to be pruriginous&#46;<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&#58; lichen planus&#8211;like&#44; urticaria pigmentosa&#8211;like&#44; and miliary cyst&#8211;like&#46; The differential diagnosis should be mainly with these entities&#46; When they affect the thorax and abdomen&#44; the lesions are usually limited to the anterior surface&#44; with involvement of the back and lower back being exceptional&#46; This characteristic may be of some help in the differential diagnosis of multiple syringomas and urticaria pigmentosa or lichen planus&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Diagnosis is usually based on histopathology&#46; The literature contains only 3 dermatoscopic descriptions of syringoma&#44; whose image varies depending on the subtype&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> Furthermore&#44; ultrasound findings have not previously been reported for this lesion&#46;</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&#44; Nicolau-Balus syndrome&#44; and Costello syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Incel Uysal et al&#46;<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&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Treatment is usually ineffective&#44; and there is a risk of recurrence and scarring&#46; Destructive methods have also been used&#46; These include CO<span class="elsevierStyleInf">2</span> laser&#44; dermabrasion&#44; chemical peels&#44; electrocautery&#44; surgical removal&#44; and topical treatment &#40;retinoids and atropine&#41;&#46; CO<span class="elsevierStyleInf">2</span> laser is probably the most effective treatment available today&#44; and its adverse effects are acceptable&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In conclusion&#44; we present an uncommon case of adult-onset generalized eruptive syringoma located on the abdomen&#44; thorax&#44; axillas&#44; and pelvis&#46; Given the late age of onset and low degree of clinical suspicion&#44; diagnosis was based on histopathology&#46; We also provide the first description of the ultrasound characteristics of this tumor&#44; although we found no specific defining characteristics that would enable us to distinguish this tumor from other soft tissue tumors&#46; Finally&#44; we wish to highlight the importance of including papular skin conditions at any age in the differential diagnosis of generalized eruptive syringoma&#46;</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&#46;</p></span></span>"
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Case for Diagnosis
Recent Onset of Multiple Asymptomatic Brownish Papules
Múltiples pápulas parduzcas asintomáticas de reciente aparición en el tronco
M. Quintana-Codinaa,
Autor para correspondencia
mquintanacodina@gmail.com

Corresponding author.
, M.T. Fernández-Figuerasb, M. Salleras Redonneta
a Servicio de Dermatología, Hospital Universitari Sagrat Cor, Barcelona, Spain
b Servicio de Anatomía Patológica, Hospital Universitari Sagrat Cor, Barcelona, Spain
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    "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&#46; The lesions had appeared gradually during the previous year&#46;</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&#8239; mm in diameter located mainly on the abdomen and also on the thorax&#44; axillas&#44; and pelvis&#46; The lesions were negative for the Darier sign &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</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 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">High-frequency ultrasound &#40;18&#8239;MHz&#44; MyLab 25Gold&#44; Esaote&#41; revealed well-defined oval lesions in the superficial dermis&#46; These were slightly hypoechogenic with respect to the adjacent dermis and heterogeneous in terms of content &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; Color Doppler did not reveal blood flow in the lesions&#46;</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 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">&#91;&#91;&#63;&#93;&#93;What is your diagnosis&#63;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Generalized eruptive syringoma&#46;</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&#46; The initial option was topical tretinoin 0&#46;05&#37;&#44; although little improvement was observed at 6 months&#46; Subsequent alternatives were rejected by the patient&#46;</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&#46; They are more common in women and are usually found in clusters on the eyelids&#46; The eruptive variant is rare and normally appears in childhood or puberty&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">There are 4 clinical variants of syringoma&#58; localized&#44; generalized&#44; associated with Down syndrome&#44; and familial&#46; The generalized variant comprises 2 clinical forms&#58; multifocal and eruptive&#46; The latter was described by Jacquet and Darier as an eruptive episode of papules on the neck&#44; trunk&#44; axillas&#44; and abdomen&#46; Syringomas generally first appear in childhood and extend over 2-3 years&#44; before becoming persistent&#46; They consist of multiple papules that are usually brown in color and asymptomatic&#44; although in some cases they may prove to be pruriginous&#46;<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&#58; lichen planus&#8211;like&#44; urticaria pigmentosa&#8211;like&#44; and miliary cyst&#8211;like&#46; The differential diagnosis should be mainly with these entities&#46; When they affect the thorax and abdomen&#44; the lesions are usually limited to the anterior surface&#44; with involvement of the back and lower back being exceptional&#46; This characteristic may be of some help in the differential diagnosis of multiple syringomas and urticaria pigmentosa or lichen planus&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Diagnosis is usually based on histopathology&#46; The literature contains only 3 dermatoscopic descriptions of syringoma&#44; whose image varies depending on the subtype&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> Furthermore&#44; ultrasound findings have not previously been reported for this lesion&#46;</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&#44; Nicolau-Balus syndrome&#44; and Costello syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Incel Uysal et al&#46;<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&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Treatment is usually ineffective&#44; and there is a risk of recurrence and scarring&#46; Destructive methods have also been used&#46; These include CO<span class="elsevierStyleInf">2</span> laser&#44; dermabrasion&#44; chemical peels&#44; electrocautery&#44; surgical removal&#44; and topical treatment &#40;retinoids and atropine&#41;&#46; CO<span class="elsevierStyleInf">2</span> laser is probably the most effective treatment available today&#44; and its adverse effects are acceptable&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In conclusion&#44; we present an uncommon case of adult-onset generalized eruptive syringoma located on the abdomen&#44; thorax&#44; axillas&#44; and pelvis&#46; Given the late age of onset and low degree of clinical suspicion&#44; diagnosis was based on histopathology&#46; We also provide the first description of the ultrasound characteristics of this tumor&#44; although we found no specific defining characteristics that would enable us to distinguish this tumor from other soft tissue tumors&#46; 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Información del artículo
ISSN: 15782190
Idioma original: Inglés
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