What is Syringoma?
Syringoma is a tumor in the sweat ducts that are commonly harmless. The term syringoma is derived from the word syrinx, meaning pipe or tube. They are typically found on the eyelids, but may also develop in other parts of the body with sebaceous ducts such as in the umbilicus, chest, armpits, breasts, genitals or vulva. Syringomas are rounded bumps, resembling the color of the skin or yellowish in color.
They grow up to 3 mm in diameter. Syringomas are similar with xanthelasma, which requires further evaluation to identify the two. The appearance of sweat duct tumor is primarily caused by the over productive action of sweat glands, which causes hypertrophy and tumor.
Syringoma affects both sexes, but is more common in women after puberty, and may increase is number at early and middle adulthood stage. Genetic predisposition may also be considered. People with Down syndrome have higher risk of developing the disease. Diabetic patients also may develop clear cell syringoma. In addition, people with dark skin may also have eruptive syringoma.
This tumor growth is considered a benign adnexal growth and should not be a cause of alarm. However, since these usually grow in the lower eyelids, upper cheeks and forehead, they alter the aesthetics or appearance of a person, which makes syringoma an aesthetic condition with cosmetic significance especially when there are a lot of growths.
Furthermore, syringomas are classified into 4 categories, which include:
- Localized syringoma
- Syringoma associated with Down syndrome
- Familial syringoma
- Multiple and eruptive syringoma
Causes of Syringoma
The causes of syringoma include those that increase the activity of the sweat glands leading to tumor growth. These include:
- Genetics- Certain gene factors contribute to the activity of the sweat glands causing syringoma. Syringoma is an autosomal dominant trait resulting from germ line transmission.
- Down syndrome- The chromosomal aberrations in Down syndrome also affect the functioning of the sweat glands. Up to 18% of people with Down syndrome develop sweat gland tumors.
- Diabetes mellitus- The exact mechanism is unclear, but patients with diabetes mellitus usually develop syringoma later in the progression of the disease.
- Marfan’s syndrome- Marfan’s syndrome is a disease that affects the connective tissues. The exocrine glands are also affected leading to over production of the sweat glands.
- Ehlers-Danlos Syndrome- This condition also causes the sweat glands to produce sweat and oil more leading to sweat gland tumor.
Symptoms of syringoma
Most often, syringomas are asymptomatic aside from the visible small tumor growth in the eyelids and other parts of the body. Some people may experience additional symptoms such as:
- Pruritus on the skin around the growth, aggravated by sweating
- Lesion appear cystic or translucent
- Round and flat lesions on the eyelids appear
The distribution of syringomas is described as follows:
- The lesions occur in multiples and clusters
- The lesions are systemically distributed
- The most common location is in the cheeks and eyelids
- They may also appear as linear and unilateral
Diagnosis of Syringoma
Syringoma is primarily diagnosed through physical examination of the lesions. In addition, histologic examination may be performed showing numerous sweat ducts. Skin biopsy is also essential to determine any malignancy on the area. Skin biopsy is done by getting a sample of the tissue after injection of a local anesthesia. The tissue sample is then studied under a microscope and identified if it is benign or malignant. However, this is only done when other symptoms appear similar to the occurrence of malignant tumors. Almost all patients with syringoma have a benign condition.
Treatment of Syringoma
Cosmetic considerations are the reasons for syringoma management. When left untreated, it may not cause physical health effects, however, because of its cosmetic effects, people especially women, would want to remove the skin growths. Management of syringoma focuses on removing the skin growths and avoiding scarring. Syringomas may be managed using the following approaches:
Surgery is the definitive treatment in order to remove syringoma. Surgical removal of the syringoma may be done using the following procedures:
Laser treatment is the treatment of choice employing the use of carbon dioxide or erbium.
This employs the use of electrical charge passed through a needle-like instrument to remove the tumor.
Electrodessication with curettage
This procedure is similar to cautery; however, it also employs the scraping of the skin growth.
Cryotherapy involves the use extremely cold substances to freeze the tumor and remove it. Liquid nitrogen is the most widely used chemical for cryotherapy.
Manual surgery or Excision
Syringoma may also be removed through excision of the tumor by the use surgical instruments such as knife, scissors or scalpel.
Dermabrasion involves the use of abrasive substances to remove the upper layer of the skin including the tumor growth.
Creams and ointments are also available to improve the skin around the syringoma, which helps in reducing its appearance. However, these are not usually as effective as the surgical removal of the skin growth.
Isotretinoin and tretinoin
Oral isotretinoins as well as tretinoin topical applications are Vitamin A derivatives that enhance the skin condition. It may be used to manage syringoma.
Atropine sulfate may be applied to reduce the over activity of the sweat glands and prevent the occurrence of syringoma.
This is also used to manage syringoma, but is not commonly used as the other two topical preparations.
Prevention of Syringoma
Although syringoma caused by other conditions may be difficult to prevent, the occurrence of eruptive syringoma may be prevented using these measures:
- Using astringents with witch hazel is thought to prevent syringoma by enhancing the integrity of the skin. Other cleansers are also essential to maintain a clean and rejuvenated skin.
- Use sun blocks when going outdoors
Sun blocks protect the skin from the harsh rays of the sun. Prolonged exposure to the sun may cause sun burn and increase the risk for syringoma formation. People with syringoma may have increased exacerbation of the skin condition when exposed too long under the sun without any protection.
Syringoma does not usually result in medical complications because it is benign and harmless. However, syringoma may lead to body image disturbance especially when it develops on the face. It becomes a cosmetic condition especially for women. Surgical removal of syringoma may also result in permanent scarring; however, this is only minimal.
Syringoma has good prognosis because of being benign. After surgical removal and treatment, it does not usually reoccur.
Syringoma in Different Sizes
Syringoma That Occur Singly
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