Brown bumps persist on chest and trunk

July 1, 2010

A 15-year-old girl is desperate for you to treat brown bumps on her chest, neck and trunk that have increased in number over the last 8 years.

The Case

Diagnosis: Generalized eruptive syringoma

Syringoma is a benign eccrine tumor that usually occurs in multiples. It commonly appears in the periorbital area but may be found on the scalp, forehead, cheeks, axillae, abdomen, extremities, and genitalia.1 Syringomas present clinically as 2-mm to 4-mm, firm, skin-colored papules. Syringomas more frequently affect women and have a hereditary basis in some cases. Most patients are Asian or dark-skinned. Lesions may develop at any age, but most frequently they appear during the third and fourth decades and, over time, become more numerous.2 In children, syringomas are most often seen in association with diabetes mellitus, trisomy 21, and Marfan syndrome.1,3

Generalized eruptive syringoma is a rare variant that presents as a widespread papular eruption (Figure 2). Lesions occur in large numbers and in successive crops on the anterior chest, neck, upper abdomen, axillae, and the periumbilical region during childhood or at puberty. The lesions are benign, typically do not progress, and rarely resolve without treatment.4

TREATMENT

Reassurance is often the best treatment because syringomas are benign neoplasms with negligible proliferative capacity. They can be treated with punch excision, cryotherapy, diathermy, trichloroacetic acid applications, or electrodesiccation with and without curettage, but all of these approaches have variable results.7 These therapies have the potential for scarring and recurrence. Recently, several investigators have reported successful treatment of periorbital syringomas with carbon dioxide laser.1,8