Asymptomatic Skin-colored Papules on the Neck
Year: 2025
Type: article
Study design: Case Report
Abstract: A 22-year-old female presented with multiple, asymptomatic, skin-colored, raised lesions on the front of her neck for the past 6 years. No similar lesions were observed elsewhere on the body, and there were no similar complaints in the family. The patient denied prior use of any medications before the development of the lesions. The lesions showed no seasonal variation. On examination, there were multiple, flat-topped, 2–3 mm-sized, skin-colored, discrete papules distributed over the anterior aspect of the neck [Figure 1a and b]. Dermoscopy of the lesions showed multiple, pigmented clusters of brown pseudo-network and multiple white dots [Figure 2]. Histopathologic examination revealed basaloid cells arranged in a small nest-like pattern with eosinophilic cuticles and focal areas of stromal fibrosis [Figure 3a], some of which exhibited a comma or tadpole shape [Figure 3b].Figure 1: (a and b) Multiple, flat-topped, 2–3 mm-sized skin-colored, discrete papules distributed over the anterior aspect of the neckFigure 2: Multiple, pigmented clusters of brown pseudo-network (circle) and multiple white dots (arrow) (medicam 1000, polarized mode, ×10)Figure 3: (a) Basaloid cells arranged in small nest-like pattern with eosinophilic, cuticle, and focal area of stromal fibrosis (H and E, ×100) (b) Comma- shaped extension of epithelial cells giving tadpole appearance (Black arrow)- (H and E, X400)Based on the clinical, dermoscopic and histopathopathological features, we arrived at a diagnosis of eruptive syringomas. Discussion Syringomas are benign tumors that mostly affect women at puberty. They originate from the acrosyringium, the intraepidermal component of the eccrine sweat glands. Typically, syringomas manifest as soft, skin-colored to slightly yellow papules over the periorbital area, neck, chest, upper abdomen, periumbilical region, and axillae. Eruptive syringomas (ES), a rare subtype, occur over the anterior surfaces of the body, such as the neck, chest, and arms.[1] Some studies have noted these lesions to be hyperpigmented, erythematous with a positive Darier sign, or with pseudo-koebnerization. Typically, palms and soles are spared, and lesions do not involve mucosal areas.[2] Syringomas can be categorized into four main clinical variants based on their features and associations: localized, familial, linked with Down syndrome, and generalized forms, including ES.[1] Despite various theories, the exact cause of ES remains unclear and may involve a hyperplastic response of the eccrine ducts to inflammation triggered by other causes. While some researchers suggest syringomas develop from sporadic or hereditary factors, they appear to be more prevalent in individuals with Down syndrome, Marfan syndrome, Ehlers–Danlos syndrome, and Nicolau–Balus syndrome.[3] The clinical differential diagnoses for this condition include acne vulgaris, sebaceous hyperplasia, Darier’s disease, Fox–Fordyce disease, verruca plana, lichen planus, mastocytosis, granuloma annulare, lichen nitidus, pseudoxanthoma elasticum, trichoepithelioma, and sarcoidosis.[2] Dermoscopy is a simple, quick, and noninvasive method that aids in distinguishing syringomas from other skin-colored papules, enhancing clinical diagnostic accuracy. ES often shows multiple pigmented clusters containing a brown pseudo-network and multiple white dots, which would appear larger than those over uninvolved skin. The dermoscopic features of various conditions that can be confused with syringoma are summarized in Table 1.[4] Histopathologically, ES presents as a circumscribed proliferation of small and large ducts in the superficial dermis, with larger ducts dilated and filled with secretion. Smaller ducts may exhibit comma-shaped extensions, known as the “tadpole pattern,” within a fibrous stroma in the upper dermis. In addition, melanin may be present in the rete ridges.[4] Treatment for ES is primarily aimed at addressing cosmetic concerns, as the condition does not pose significant long-term morbidity or mortality risks. There is a wide array of treatment modalities available, all with the main objective of reducing scarring and minimizing recurrence. These modalities include dermabrasion, various excision techniques, cryosurgery, electrodesiccation, chemical peeling, oral and topical retinoids, carbon dioxide laser therapy, and topical atropine. Oral isotretinoin is often utilized due to its systemic impact on lesions, although it does not notably influence recurrence rates.[2] Park et al. have shown moderately effective outcomes through the utilization of a Q-switched alexandrite laser followed by temporary tattooing.[5] Surgical interventions are generally less favorable due to the extensive distribution of the lesions.[2]Table 1: Dermoscopic differential diagnosis of conditions confused with eruptive syringomaDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Source: Clinical Dermatology Review
Authors: Spandana Prakash Hegde, Safeera Abdul Khadar, Malcolm Pinto, M H Shariff
Institution: Yenepoya University
Language: English
Topic: Cancer and Skin Lesions
Subfield: Dermatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4412090199