Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Syringomata
Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports
Syringomata are benign appendageal tumors of the intraepidermal eccrine sweat duct that have a characteristic histologic appearance. Typically skin- or tan-colored papules, with a rounded or flat surface, 1–5 mm in diameter, appear around puberty. Single tumors can occur, but more commonly they are multiple and symmetric, more common in females, and from adolescence onward. Syringomata most often involve the lower eyelids, although they may occur at other sites, including the cheeks, axillae, abdomen, and vulva. Linear, familial eruptive and generalized forms have all been described. Histologically, syringomata are situated in the upper to mid-dermis, the depth of which affects treatment modalities.
Management Strategy
This chapter will focus on facial syringomata. Available treatments, most of which are ablative, remove or flatten the papule produced by each syringoma. Some patients with only a few individual lesions may consider excision . Ablative modalities include scissor excision with secondary-intention healing, surgical excision of the entire cosmetic unit of the lower eyelids in patients who would also benefit from lower eyelid blepharoplasty, as well as electrocautery , electrodesiccation , intralesional electrodesiccation , dermabrasion , cryotherapy , radiofrequency ablation , and laser treatment (CO 2 monotherapy or in conjunction with other treatment modalities, neodymium:yttrium-aluminum-garnet [ Nd:YAG], or erbium:YAG [Er:YAG]). When determining which laser therapy to choose, there are no studies comparing different lasers. There is one study analyzing CO 2 laser monotherapy in comparison to CO 2 laser combined with botulinum A toxin . This study concluded that the combination was more efficacious than the laser alone.
Topical or locally injected anesthesia is needed before treatment. Local anesthetic injections producing a field block are most commonly employed, as good anesthesia is helpful when using ablative treatments near the eye. Patients should be warned about the possibility of postoperative bruising. Eye protection is of paramount importance, and specific precautions relevant to the use of lasers must be taken if laser treatment is used.
Ablative treatments will produce some degree of scarring and the aim is to make this imperceptible for excellent cosmetic results. Possible sequelae, including scarring and hypo- or hyperpigmentation (especially with increasing skin pigmentation), should always be discussed before treatment.
In addition to ablation, there are case studies analyzing pharmacotherapy for novel treatment types. These include topical trichloroacetic acid, atropine, and tretinoin . As more treatment options and efficacy studies become available, these non-surgical routes may become more feasible options.
Due to the lack of follow-up data and high level of evidence clinical trials, choosing a modality for treatment can be challenging. Because each modality has pitfalls in addition to benefits, determining the treatment option with the most user-experience may be wisest. Ultimately, treatment should be determined through a discussion between the patient and physician.
Specific Investigations
The clinical features of periorbital syringomata are usually diagnostic, and a skin biopsy may be undertaken for confirmation or when there is uncertainty.
First-Line Therapies
An easy method for removal of syringoma
Maloney ME. J Dermatol Surg Oncol 1982; 8: 973–5.
A single case is reported with a good outcome after removal of four to six lesions per session in 12 sessions over 5 months.
A good photographic demonstration of the removal of periorbital syringomata with fine ophthalmic spring-action scissors.
True electrocautery in the treatment of syringomas and other benign cutaneous lesions
Langtry JAA, Carruthers JA. J Cutan Med Surg 1997; 2: 60–3.
The technique of electrocautery is described, and good results reported in a number of benign skin lesions, including syringomata.
Intralesional electrodesiccation of syringomas
Karam P, Benedetto AV. Dermatol Surg 1997; 23: 921–4.
Twelve patients were treated with electrodesiccation via a fine electrode into the center of the syringoma with the aim of localizing the effect and minimizing scarring. All reported excellent results and no recurrence after a follow-up of 18–48 months. Two patients with Fitzpatrick skin type IV had focal hyperpigmentation, which cleared in 2–3 months.
Intralesional electrocoagulation with insulated microneedle for the treatment of periorbital syringomas: a retrospective analysis
Ahn GR, Jeong GJ, Kim JM, et al. Aesthet Surg J 2019 Oct 21. pii: sjz288. https://doi.org/10.1093/asj/sjz288 [Epub ahead of print].
Fifty-five patients with periorbital syringoma underwent intralesional electrosurgery with approximately half experiencing marked reduction after one treatment. As treatments continued, number of lesions and remaining lesion severity decreased.
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here
