Syringoma

What is Syringoma?

Syringomas are harmless growths that start from skin-associated structures. The term “syringoma” is related to “acrosyringium,” which refers to the part of a sweat duct within the skin. Therefore, syringomas are characterized as having a steam or duct-like structure that originates from cells of sweat ducts, usually the types called eccrine, although they can also originate from a type called apocrine. These growths often appear during early adulthood and are more common in women. They usually appear as skin-colored bumps, often around the eye area. Syringomas generally don’t cause any discomfort, but people may choose to have them removed for beauty reasons. Several treatment methods have been tried, with varying levels of success. It’s crucial for healthcare providers to understand syringomas to understand their clinical significance and provide the best care for their patients.

What Causes Syringoma?

Syringomas are a type of skin tumor that grow from parts of the skin’s sweat glands. While lots of these tumors have been studied, their cause is still unclear. Some researchers believe it could be related to our genes, but no specific gene faults or inherited risks have been found yet.

Many people get their first syringoma during young adulthood, which has led to the theory that these tumors might be linked to hormonal imbalances. Other possibilities that researchers are exploring include the idea that syringomas could start because of inflammation related to injury, immune system disorders, or sensitivity to heat.

There’s also some evidence to suggest a link between syringomas and diabetes, as well as specific types of syringomas, which might be due to problems with how the body regulates blood sugar levels. A genetic influence is also possible, as there have been rare cases where syringomas seem to run in families.

Even though these connections have been made, the exact ways in which these tumors form on the skin remain uncertain.

Risk Factors and Frequency for Syringoma

Syringomas typically start to appear during early adulthood. These skin bumps more commonly affect females and individuals of Asian heritage. There’s also a specific type of syringoma, known as the clear cell variant, that’s commonly seen in people with diabetes. While syringomas generally occur on their own, there are cases where they’ve been observed to run in families, following a pattern where they are likely to be passed down from parent to child.

Although hundreds of cases of syringomas have been documented, they are usually an isolated condition. However, those with certain genetic syndromes might also have an increased chance of developing syringomas. This is particularly true with individuals who have Trisomy 21 (Down Syndrome), Ehlers-Danlos Syndrome, or Marfan Syndrome.

Signs and Symptoms of Syringoma

Syringomas are skin growths that often appear around the eyes, particularly on the lower eyelids. They can also occur on the forehead, cheeks, genital area, or underarms. Usually, these are multiple, separate, firm lumps that are about 2 to 4 millimeters in size. On rare occasions, syringomas may show up on the palms of the hands and the soles of the feet, which are areas only containing eccrine sweat glands and no apocrine glands. These are known as acral syringomas.

These skin bumps often begin to develop during the teenage years and may do so in an “eruptive” pattern, suggesting hormones may play a role. They can appear in various parts of the body, especially the trunk, as several skin-colored, yellow, or pink bumps measuring 1 to 2 millimeters each. Although these eruptions do not cause any symptoms, they can last for years. Some reports suggest that syringomas can disappear naturally over the course of several years, but most persist without treatment.

Testing for Syringoma

If you are suspected to have syringoma, a type of skin growth, your doctor will often start by taking a detailed medical history and conducting a physical exam. Syringomas usually look like many small, painless, skin-toned bumps that are well-defined and measure a few millimeters across.

In some situations, if it’s not entirely clear just from looking at it that you have a syringoma, your doctor might take a small sample of your skin, known as a biopsy. This small piece of skin will be examined under a microscope to reveal its internal structure, which can help confirm the diagnosis of syringoma.

It’s important to note that in most cases of syringoma, no other tests, like blood tests or imaging (X-ray or CT scans), are usually needed. However, if a subtype known as “clear cell” syringoma is detected, you might need an additional test to check for diabetes, as this form of syringoma can be related to it. Despite the discovery of many genetic changes in different types of skin tumors, the exact genetic changes that lead to syringoma are still largely unknown.

Another technique your doctor might use to help diagnose syringoma is dermoscopy, which is a method of looking at the skin using a special magnified lens. Dermoscopy can show specific features of syringomas such as multiple yellow to white-colored, oval-shaped spots on a backdrop of orange or pink. You could also see clusters of pinpoint or small linear blood vessels. However, this technique is not frequently used to diagnose syringomas, as there are not many reported cases where it has been used.

Final confirmation of the diagnosis of syringoma is usually obtained via a histopathological analysis, a process of examining the skin sample under a microscope. Because microscopic features may look similar to those of other skin conditions like basal cell carcinoma and other skin tumors, your doctor might use special immunohistochemical stains to precisely identify it as syringoma.

Treatment Options for Syringoma

Syringomas are non-cancerous skin growths that, once diagnosed, usually don’t require treatment unless you want them removed for cosmetic reasons, or if there’s a risk they might turn into a skin cancer known as syringomatous carcinoma. If skin cancer is suspected, it’s often removed using a precise surgical technique known as Mohs micrographic surgery. This procedure emphasizes the importance of accurately identifying the type of skin growth under a microscope to provide the best care.

While these skin growths can sometimes disappear on their own in adulthood, it’s unclear how often this happens. There are various treatments available for syringomas, including different types of surgery (like electrosurgical destruction, cryotherapy, snip excision, and punch excision) and the application of certain chemicals. These treatments have had mixed levels of success. Injecting the syringomas with a treatment that dehydrates and destroys them (a process known as intralesional electrodesiccation) is one of the more effective methods, according to medical studies. This method appears not to cause long-term harm and has low recurrence rates.

There’s no ‘one-size-fits-all’ treatment for cases when multiple syringomas appear at once (known as eruptive syringomas). When many skin growths appear on the eyelids or you have eruptive syringomas, one option might be laser treatment. Several studies have shown that using a type of laser called a CO2 laser can successfully treat syringomas while also improving the appearance of the skin.

Keep in mind that whichever treatment option you choose, it will come with potential risks. These might include scarring or the syringomas returning. Regular cryotherapy treatments, which involve freezing the syringomas to destroy them, can cause lighter skin patches in people with darker skin. Overall, coming up with a treatment plan for syringomas requires a careful and personalized approach for each patient, taking into account the unique attributes and challenges of their specific case.

What else can Syringoma be?

When diagnosing a syringoma, or a harmless sweat duct tumor, doctors can typically use a basic evaluation. However, in more complex cases that have unusual features, it might be difficult to distinguish the syringoma from other skin growths. The conditions that could be mistaken for syringoma include:

• Milia
• Angiofibroma
• Xanthoma
• Hidrocystoma
• Fibrofolliculoma
• Trichoepithelioma
• Xanthelasma
• Papular sarcoidosis
• Plane warts
• Acne vulgaris
• Darier disease
• Lichen planus
• Pseudoxanthoma elasticum
• Sebaceous hyperplasia

Doctors can distinguish these conditions from syringoma by examining the skin tissue under a microscope, which is called a histological evaluation. Syringomas typically show certain unique characteristics under the microscope, such as a lack of keratinization (hardening of the protein in the skin), no hint of multiple horn cysts (small lumps filled with keratin), and no follicular differentiation (the maturing process of a follicle).

If these attributes are missing in the histological evaluation, then the condition could be a desmoplastic trichoepithelioma, a common skin tumor that should be considered when diagnosing a syringoma, or a microcystic adnexal carcinoma. Both of these conditions can have features comparable to syringoma but also have distinguishing features as well.

Morpheaform basal cell carcinoma, another growth that can be confused with syringoma, will display other features such as follicular differentiation, horn cysts, apoptotic cells (dead cells), the absence of sweat ducts, and abnormal cells showing increased cell division, which aren’t commonly seen in syringomas.

This detailed microscopic examination helps doctors correctly diagnose the syringoma and distinguish it from other similar conditions within a clinical context.

What to expect with Syringoma

Syringomas are harmless tumors that originate from parts of sweat glands. They may be a cause for cosmetic concern, particularly if they appear in multiple areas on the face. Even so, despite occasional reports of harmful syringomas, there have been no recorded cases of them progressing to dangerous levels. Harmful syringomas tend to develop spontaneously, rather than grow from existing harmless tumors. Therefore, there is usually no need for treatment and most people who have syringomas have great outcomes.

There’s something to note about a specific type of syringomas known as eruptive syringomas. They often vanish on their own over several years. This is different from the more usual kind, which are multiple, symptomless facial spots. These usual ones usually stick around unless there is medical intervention.

Possible Complications When Diagnosed with Syringoma

Syringomas are harmless skin growths that don’t have the potential to invade other tissues or turn into cancer. Even though they pose no health risk, patients may feel self-conscious if they have many syringomas and might want a treatment to remove them. However, there can be complications from the procedures used to remove these growths. These complications may include some scarring, infections, color changes to the skin, and the return of the syringomas. Gathering precise data on how often syringomas return following treatment is challenging due to a lack of tissue samples tested under a microscope before treatment. Numerous reviews have shown that there’s a wide range of success rates among different treatment methods. Regardless, having syringomas return after treatment does not increase the patient’s risk of illness or death.

Possible Complications from Treatment:

• Scarring
• Infections
• Skin color changes
• Syringomas returning

Preventing Syringoma

Syringoma is a harmless skin condition that typically doesn’t lead to any additional health problems or affect a person’s lifespan. For most people, this condition doesn’t invade other systems in the body. Usually, doctors can diagnose syringomas just by looking at your skin and typically, no further tests or treatment are needed.

However, an exception is patients who have a special type of syringoma that can be confirmed with a skin biopsy, known as the clear cell type. This form of the condition has been linked to diabetes, so testing for this disease may be suggested.

Syringomas are also more common in individuals with Down syndrome, a genetic disorder also known as trisomy 21. Both doctors and patients with Down syndrome should be aware of this connection, but this doesn’t change the outcome or treatment of these skin growths. Syringomas mostly appear in healthy people without any family history of the condition. Nonetheless, there have been instances where syringomas have been passed down through families in what is known as autosomal dominant inheritance.

Despite these connections, the exact cause and development process of syringoma remains unknown, and there are no clear risk factors that have been identified yet.

If someone notices new and unexplained skin growths, they should see a skin doctor, also known as a dermatologist, for an evaluation. Once a biopsy confirms that the growths are syringomas, patients can rest easy knowing their condition is not life-threatening. If they’re bothered by how the syringoma looks, various removal procedures are available for cosmetic reasons.