Syringoma is one of the forms of damage to the sweat glands, having a benign tumor nature, some researchers consider it as a developmental defect (a variant of hamartoma). Symptoms of this dermatological condition are small nodules of a light or yellow hue on the skin of the face, lower eyelid, chest, occasionally in the genital area. The diagnosis of syringoma is made on the basis of the results of a dermatological examination of the patient, a biopsy and subsequent examination of the nodule tissues in the lesions. Syringomas usually have a benign slow course, so they do not require treatment – the exception is their removal for aesthetic reasons. For this purpose, methods of modern hardware cosmetology are used (laser removal, cryodestruction, diathermocoagulation), in rare cases – surgical techniques.
Syringoma (eruptive hydradenoma, multiple syringoadenoma) is a malformation of eccrine sweat glands, which is characterized by benign hyperplasia of the epithelium of the excretory ducts with the formation of cystic formations and nodules. This condition has been known for a long time, but for a long time, disputes raged about the mechanisms of its occurrence in the scientific community – the role of congenital malformations, carcinogenic factors and other circumstances was assumed. Currently, the most common point of view is the hypothesis of polyethologicity of syringoma – it is believed that this benign tumor of the sweat glands can develop under the influence of a wide variety of factors. This pathology affects women more often (more than 80% of all patients), adolescents and the elderly predominate in the age distribution, and syringoma occurs relatively rarely in middle age. It is quite problematic to determine the occurrence of the disease, since many patients do not turn to a dermatologist because of the low severity of the symptoms of the disease.
The etiology of syringoma is currently considered multiple – both congenital factors (malformations of eccrine sweat glands) and endocrine disorders or metabolic disorders can lead to this condition. Eccrine sweat glands are located almost over the entire surface of the body, especially on the face, while the mechanism of their secretion is not associated with cell destruction (as in the case of apocrine glands). Several cases of familial forms of this dermatological disorder have been described, which indicates the possible genetic and hereditary nature of the disease. It is noted that pathology occurs much more often in people with Down syndrome, Marfan syndrome, diabetes mellitus and obesity, which confirms the polyetiology of a benign neoplasm. Syringoma almost never leads to the development of a malignant tumor. Cancer of the ducts of the eccrine sweat glands (syringocarcinoma) occurs independently of this dermatological condition.
The pathogenesis of syringoma development is more studied than the causes of the disease. With the help of morphological and histochemical studies, it was found out that the anomaly affects the epithelial cells of the excretory ducts of the eccrine sweat glands. For one reason or another, the differentiation of the epithelium of the intraepidermal area of these glands decreases, in particular, contact inhibition of division is inhibited, a flat unicellular layer is formed. As a result, uncontrolled division of epithelial cells occurs, which first leads to blockage of the excretory duct of the gland, and then to the formation of intraepidermal cysts lined from the inside with pathological epithelium. Externally, this is manifested by the development of syringoma in various areas of the skin.
Syringoma affects women more often, which gave rise to some researchers to suggest the relationship of this condition with female sex hormones. Usually, such a pathology occurs during puberty or in post-menopausal age, which also indirectly indicates this connection (during these periods there are significant fluctuations in the hormonal background). The main areas of the location of syringoma nodules are the lower eyelid, face, chest and hands, the spread of nodules is most often symmetrical. In those rare cases when such a condition develops in men, neoplasms are usually found in the groin area or on the trunk. Less frequent localizations of syringoma are the scalp, legs, buttocks and back. In dermatology, syringoma of the lower eyelid and eruptive syringoma are sometimes separated – any skin neoplasm of this type that has developed in other parts of the body.
The onset of the disease is characterized by the appearance of minor protrusions on the surface of the skin (in extremely rare cases, a single tubercle is formed). At the first stage of syringoma formation, there are no other manifestations, both objective (redness of the skin, inflammation) and subjective (pain, itching, burning). The development of the neoplasm occurs over many years and even decades, gradually a white or light yellow nodule appears in place of the lump of unchanged skin, no more than 4-5 millimeters in size. The skin on the surface of the syringoma becomes thinner, shiny and translucent. As a rule, such neoplasms are located in close groups, but they never merge with each other.
With a prolonged course of syringoma, the color of neoplasia can slowly change from light to pink or even purple – this is especially often the case when nodules are traumatized. In cases where tumors form on the scalp, foci of alopecia appear around them. During the entire development of syringoma, no subjective symptoms of pathology arise, only in case of damage to the neoplasm, patients may complain of minor itching. The progression of the condition may manifest itself in the form of the formation of new nodules in the immediate vicinity of the primary lesion zone.
For the diagnosis of syringoma, the method of dermatological examination, questioning and examination of the patient’s anamnesis, as well as histological examination of the tissues of pathological formations are used. On examination, light or yellowish multiple nodules are found, somewhat protruding above the surface of the skin and not merging with each other. As a rule, neoplasia is located in the lower eyelid, face and neck, on the hands, abdomen and chest. When questioning and studying the anamnesis, the absence of subjective symptoms is revealed, a significant duration of the existence of syringoma (many years may pass between the appearance of the first manifestations and a visit to a dermatologist), the presence of similar disorders in relatives. The latter circumstance may indicate a hereditary predisposition. An indirect sign of syringoma may be the presence of other pathologies in the patient – both genetic (Down syndrome, Marfan) and acquired (diabetes mellitus and other endocrine disorders).
A biopsy of cutaneous elements with histological examination of a tissue sample provides much more diagnostic information about syringoma. In the course of the study, the thinning of the epidermis, the presence of many microscopic cysts in its thickness and the surface layers of the dermis, the walls of which are formed by several rows of cells morphologically similar to the epithelium of the ducts of the eccrine sweat glands, are revealed. The contents of cyst in syringoma are usually homogeneous, in the case of long-term developing neoplasms, they can be represented by masses of keratin and calcified elements. Around the cysts, cellular strands of dark small cells are determined, forming the main part of the tumor. Histochemical examination of syringoma tissues indicates increased activity of some enzymes (phosphorylase, succinate dehydrogenase). These enzymes are characteristic of the cells of the eccrine sweat glands, which additionally indicates the mechanism of formation of these tumors.
Given the long and benign course of syringoma, as well as the almost zero probability of its degeneration into a malignant skin tumor, most dermatologists believe that therapy for this condition is not required. Moreover, the removal of such neoplasms in the elderly carries a much greater threat due to the development of scars and the possible addition of a secondary infection. In the presence of syringoma on the lower eyelid, face or chest, many patients wish to eliminate such nodules for aesthetic reasons.
Methods of modern hardware cosmetology are widely used to combat neoplasms: laser ablation of tissues, cryodestruction, electrocoagulation (diathermocoagulation). In most cases, when used correctly, these methods provide reliable removal of neoplasms without noticeable traces, but do not prevent the recurrence of syringoma. Sometimes the consequences of such treatment (scars, pigmentation disorders) may be more noticeable than the nodules themselves, which should be taken into account when prescribing the above procedures.
Prognosis and prevention
The prognosis of syringoma is favorable, the tumor does not threaten the life and health of the patient and has no subjective manifestations even when located on such a sensitive area as the skin of the lower eyelid. Taking into account the fact that neoplasms very often affect open areas of the body (face, decollete area, hands), the aesthetic factor should be taken into account when assessing the disease. After removal of syringoma by one method or another, in addition to possible consequences in the form of scars and scars, a relatively high risk of relapse remains. Prevention of the development of this dermatological condition is reduced to timely correction of endocrine and metabolic disorders, especially in the presence of a genetic predisposition to syringomas.