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Eruptive pruritic syringomas: Treatment with topicalatropine

      To the editor:

      Syringomas are common benign tumors of eccrine origin. Eruptive syringomas represent a variant of syringomas that arise in successive crops on the anterior body surface usually before or during puberty. Although syringomas are usually asymptomatic, they may sometimes be pruritic.
      • Patrizi A
      • Neri I
      • Marzaduri S
      • et al.
      Syringoma: a review of twenty- nine cases.
      • Sánchez del Rio J
      • Stefaniak H
      • Nosti D
      • et al.
      Hidradenoma eruptivo.
      • Kuttner BJ
      • Kaplan DL
      • Rothstein MS
      Eruptive pruritic papules.
      We describe a patient with disturbing eruptive syringomas; successful treatment with 1% topical atropine resulted in disappearance of the pruritus and a discrete reduction in the size of the lesion.
      A 27-year-old woman described the appearance of multiple brown papular lesions that came in successive crops over a period of 15 months; the papules were located on her chest and neck. The patient's cosmetic appearance was troubling to her from the outset, and she complained that the lesions were intensely pruritic. Results of blood cell count and serum biochemistry were normal. A biopsy specimen showed typical findings of syringomas. We started treatment with oral cetirizine and topical corticosteroids without achieving any reduction of the intense pruritus. The lesions remained and new papules appeared. Topical atropine (1%) in aqueous solution was then applied once daily (approximately 0.75 mL/day, equivalent to 7.5 mg sulfate of atropine). The pruritus was alleviated and disappeared entirely in a few days; a discrete size reduction of the syringomas was obtained. The patient has remained without symptoms during 4 months of therapy. Evaluation of heart rate and an ophthalmologic examination that included best-corrected visual acuity (distance and near vision), anterior segment biomicroscopy, intraocular pressure, monocular and binocular amplitude of accommodation, and pupil evaluation (size and reaction to light) was performed during follow-up. Evaluation was within normal limits except for a slight asymptomatic decrease of the accommodation amplitude of both eyes. No local and systemic side effects, including inhibition of sweating, dryness of mouth, thirst, blurred vision, palpitation, headache, difficulty in micturition, or reduced intestinal peristalsis, were observed.
      Therapy for syringomas is unsatisfactory. Surgical, oral, and topical treatments have limited results. The appearance and associated intense pruritus of symptomatic eruptive syringomas have failed to be alleviated by the use of various over-the-counter lotions, topical and oral corticosteroids, topical antifungal agents, and topical retinoids.
      • Kuttner BJ
      • Kaplan DL
      • Rothstein MS
      Eruptive pruritic papules.
      On the other hand, multiple eccrine hidrocystomas have been treated successfully with oral and topical anticholinergic drugs, achieving the transitory clearing of lesions and alleviation of symptoms.
      • Dostrovsky A
      • Sagher F
      Experimentally induced disappearance and reappearance of lesions of hidrocystomas.
      • Masri-Fridling G
      • Elgart M
      Eccrine hidrocystomas.
      • Armstrong D
      • Walsh MY
      • Corbett JR
      Multiple facial eccrine hidrocystomas: effective topical therapy with atropine.
      Given that syringomas have a similar origin to eccrine hidrocystomas and that atropine inhibits sweat secretion, we decided to use this drug to treat multiple pruritic eruptive syringomas; we achieved the complete alleviation of pruritus and a discrete size reduction of lesions without local and systemic side effects. Based on our case, we suggest that topical atropine could be effective and safe in the treatment of symptomatic eruptive syringomas.

      References

        • Patrizi A
        • Neri I
        • Marzaduri S
        • et al.
        Syringoma: a review of twenty- nine cases.
        Acta Derm Venereol (Stockh). 1998; 78: 460-462
        • Sánchez del Rio J
        • Stefaniak H
        • Nosti D
        • et al.
        Hidradenoma eruptivo.
        Actas Dermo-Sif. 1982; 73: 121-124
        • Kuttner BJ
        • Kaplan DL
        • Rothstein MS
        Eruptive pruritic papules.
        Arch Dermatol. 1989; 125: 985-990
        • Dostrovsky A
        • Sagher F
        Experimentally induced disappearance and reappearance of lesions of hidrocystomas.
        J Invest Dermatol. 1942; 5: 167-172
        • Masri-Fridling G
        • Elgart M
        Eccrine hidrocystomas.
        J Am Acad Dermatol. 1992; 26: 780-782
        • Armstrong D
        • Walsh MY
        • Corbett JR
        Multiple facial eccrine hidrocystomas: effective topical therapy with atropine.
        Br J Dermatol. 1998; 139: 558-559