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Case Reports

Abstract

Syringomas are benign skin tumors arising from intraepidermal eccrine ductal epithelium that commonly present as yellow, brown, or skin-colored papules. Patients with Down syndrome have an increased propensity for developing syringiomas that most commonly occur in the periorbital area. Eruptive syringiomas are a rare subtype of syringiomas where numerous lesions appear in an acute, eruptive fashion and are located on two or more anatomic parts of the body. We present a rare occurrence of eruptive syringiomas in a patient with Down syndrome. A 22-year-old female with Down syndrome, hidradenitis suppurativa, and hypothyroidism presented with a complaint of a new rash on her face, chest, back, and bilateral upper arms.  The lesions appeared suddenly but had been present for 10 years. Physical exam showed scattered, indurated pink to red papules and small plaques without scale or surface change located on her bilateral upper arms, chest, and bilateral temples. Biopsy of a lesion on the left upper arm demonstrated a well-circumscribed, dermal-based proliferation of epithelial strands of cells with ductal differentiation within a sclerotic stroma. Due to the benign nature of the lesions, the patient deferred treatment. Because of their diffuse and eruptive nature, syringomas can be mistaken for an inflammatory process by clinicians and patients alike.  Histologic examination and skin biopsy with clinical-pathologic correlation are critical for accurate diagnosis in these cases.   Although syringomas most commonly occur in Down syndrome patients in a periocular distribution, eruptive cases can occur as highlighted by our case.