Syringoma

A 45-year-old man presented to a dermatology clinic for evaluation of lesions around his eyes. He had first noticed them several years previously, but the lesions had been growing in size and number since then. Totally asymptomatic, the lesions were of purely cosmetic concern.

Physical examination. The skin-colored sessile papules, each measuring 1 to 3 mm, were sparsely grouped around the periocular area, primarily on the lids, and were visible only with oblique light. The lesions were quite soft on palpation. Examination findings of the rest of the skin were unremarkable.

Discussion. Syringomas are uncommon but by no means rare. They are harmless eccrine duct tumors that are typically seen, as in this case, around the eyes, more commonly in women than in men. Syringomas are more common in persons with diabetes mellitus and with Down syndrome.

Although there are several different types of syringoma, the type seen in this patient’s case are by far the most common. A number of triggers for syringomas have been postulated, including eczema and even hormones.

Other lesions in the differential diagnosis of syringomas include sebaceous hyperplasia, warts, xanthelasma, and milia. Biopsy can differentiate among these conditions but is seldom necessary.

Treatment is rarely done but involves a destructive modality such as a laser, electrodesiccation, or cryotherapy. Besides being tedious and painful, these treatment choices all carry the risk of permanent alteration of the skin.