What Is Syringoma

Introduction

Definition of syringoma

Syringoma can be defined as a benign growth of the sweat glands, which appear as small bumps on the surface of the skin. Syringoma appear very similar to pimples ranging between 1–3mm and are usually clustered around the eyelids and on the face.¹ Syringoma bumps are skin coloured or yellowish in colour and despite their appearance they are harmless to patients. In some cases, patients may suffer from slight inflammation and experience some itchiness around the spots.

The importance of understanding syringoma

Understanding syringoma is important as they are benign tumours deriving from sweat glands and ducts.² Syringomas can occur in anyone, but they are more common in women than men, and in people who are diagnosed with Down Syndrome or Marfan syndrome. Up to 20% of Down syndrome patients are diagnosed with syringomas but diagnosis is rarer in other populations. Patients who have a  lighter skin tone are also more likely to suffer from syringoma, especially women of Japanese and Caucasian descent,²but eruptive syringoma affects darker skin tone more. Those who suffer from syringoma are usually early adolescents during puberty, and adults over the ages of 40.

Types of syringoma

There are several types of syringoma depending on which sweat glands the benign growth is present in, and the location of the sweat glands.³ The different syringomas can vary in their appearance and who it affects. 

Eccrine syringoma

Eccrine syringoma is defined as benign tumour growth in the eccrine sweat glands within the epithelial cells.⁴ The eccrine sweat glands are the most common sweat glands and found throughout the entire body.⁵ Eccrine sweat glands play an important role in regulating internal body temperature.⁵ Eccrine syringomas are characterised by multiple small bumps on the face, appearing as skin-coloured or yellow spots.⁶ These are usually found on the eyelids of patients but can be found anywhere on the body⁴ and are more common in younger women.⁷

Apocrine syringoma

Apocrine syringomas are also benign tumour growths, but within the apocrine sweat glands instead. Apocrine sweat glands are larger and more branched compared to the eccrine sweat glands,⁵ and are limited to areas with a lot of hair follicles such as the scalp, armpits and the genital areas.⁸ Apocrine glands become activated after puberty occurs and release the sweat responsible for body odour.⁵ Apocrine syringomas are characterised by hyperpigmented, firm bumps around  3–5mm in diameter.⁹ They are usually located in areas where the apocrine sweat glands are concentrated and are not found on the face, abdomen or hands of patients.⁹ 

Multiple syringoma

Multiple syringoma, also known as generalised eruptive syringoma, is a rare form of syringoma.¹⁰ Multiple syringoma is an eccrine syringoma as it originates within the eccrine sweat glands, however the number of lesions and bumps are much higher and are widespread all over the body– in the upper body including the chest and neck, the shoulders and armpit areas, and the abdomen area surrounding the belly button.¹⁰ This type of syringoma occurs more frequently in women, and usually more often in adults.¹⁰ Multiple syringoma is characterised by multiple small firm spots of a yellow to brown colour that are symmetrically distributed.¹⁰ Multiple syringoma is also benign and poses no harm to patients other than affecting their appearance. 

Familial syringoma

 Familial syringoma is a rare type of syringoma that can be inherited from your biological parents.² It  is autosomal dominantly inherited. This means that if one of the biological parents are carrying the gene for familial syringoma, then their child has a 50% of developing familial syringoma. The causative mutation that causes this gene is not yet determined. 

Causes and risk factors of syringoma

Syringoma occurs when the sweat glands (either eccrine or apocrine) become overworked and the cells within the glands grow too much, which forms the bumps on the skin’s surface. Syringoma is a common benign sweat gland growth but the cause is not fully understood. However, there are several risk factors that can cause excess sweating through the overworking of the sweat glands:

• High levels of stress
• Exercise or physical activity
• High temperature
• Genetic mutations
• Certain medical conditions like diabetes²

The chances of developing syringoma are increased if the patient:

• Has a history of syringoma in the biological family (i.e, if their biological parent also developed syringoma)
• Has Down syndrome 
• Has diabetes that is not well controlled.

Having these risk factors does not mean that someone will definitely develop syringoma. Instead, it means that a patient with some of these risk factors is more likely to develop syringoma than an individual with fewer risk factors. 

Symptoms of syringoma

There are several symptoms of syringoma and they can affect different parts of the body, usually surrounding the sweat glands.²

Syringoma symptoms include:

• A round bump on the skin that is 1–3 mm in diameter.²
• The bump is firm and does not move around.²
• The bump is skin coloured, yellow or translucent.²
• Syringoma bumps are clustered together in a group that are all similar in shape, size and colour.²

Common sites on the body include:

• The eyes and surrounding areas.²
• The face, cheeks, and neck.²
• Upper body including the chest and in the armpits.
• On and surrounding the genital areas.²

Diagnosis of syringoma

A clinical examination of the skin bumps are first analysed by a trained healthcare profession where the colour, shape and size of the bumps is assessed. If the doctor suspects syringoma, they will order a biopsy of the syringoma to rule out other similar skin tumours. This means that a health provider will numb the affected area and remove a sample of your affected skin, ² which will be sent to the lab for tests to be conducted. There are two main clinical methods¹¹ to determine if the spot on the skin is syringoma:

• Fine needle aspiration cytology (FNAC)
• Histopathology

FNAC is a less invasive process where the fluid from the bump is removed during the biopsy, whilst histopathology will require skin tissue to conduct the diagnosis. Despite the ease and convenience of FNAC, it is not enough to diagnose syringoma completely,¹¹ and histopathology is used to confirm the diagnosis. In histopathology, the syringoma has the appearance of a tadpole under a microscope, which is characteristic of syringoma and confirms the diagnosis.

Treatment of syringoma

Syringoma is a benign growth, with no risk to patients and which doesn’t require any treatment. However, syringoma can affect the way you look visually and there are options available to remove the spots from the face. 

Most syringoma treatments are minimally invasive, which means that they are low risk with little scarring and a quick healing time. They can be carried out by a dermatologist or plastic surgeon. There are several common minimally invasive² treatments:

• Electrosurgery uses heat generated from an electromagnetic current source like radio or sound waves to remove the skin bumps from the skin.¹²
• Laser therapy uses a narrow, thin light beam on the affected area of the skin to reduce the visibility of the syringoma²
• Cryotherapy involves the use of very low temperature that will freeze and then remove the syringoma bumps.
• Dermabrasion is a procedure whereby the plastic surgeonsremove the syringomas by scraping away the top layer of the skin to leave behind a clear skin layer.¹³
• Topical creams are medicines that can be applied on top of the skin like a lotion.² Common topical creams include trichloroacetic acid, which is applied on top of the skin and works like a chemical peel, peeling off the affected skin area and leaving behind healthy skin.² 

If the minimally invasive treatments do not work, doctors may use excision treatment, where surgical tools like scalpels or scissors are used to cut the syringoma off. However, this treatment is not recommended for darker skin tones as it could form a hypertrophic scar and can also cause a difference in pigmentation that could take time to heal.¹³ 

Cauterisation is a method that burns off the syringoma but this method also leaves scarring.⁴

After treatment, aftercare will be discussed with the healthcare profession and you will need to give time for the skin to heal.² The length of time taken to heal will depend on the type of treatments you were given.

Prognosis and complications

Syringoma is a harmless condition that only changes the visual appearance of the skin. There is no known complication associated with syringoma and there should be no itchiness or swelling around the spots. However, there could be some complications if a patient decides to remove the syringomas surgically, which could lead to some scarring and discolouration.² There is also a chance of the syringoma returning following treatment.²

Prevention and self-care

There is no definite method of preventing syringoma, but there are steps available to reduce the risk of developing the condition. 

• Reducing stress: As stress is a factor that can increase the likeliness of developing syringoma, reducing stress is a preventative method. You can reduce stress by changing your diet, decreasing smoking and drinking, exercising more and sleeping well.
• Healthy blood sugar: Keeping your blood sugar levels healthy if you are diabetic helps, as syringoma can develop if diabetes is not controlled. 
• Wearing suncream to protect yourself from the sun can reduce the likelihood of developing syringoma, as it reduces  sun damage.

Summary

To summarize, syringoma is a harmless benign growth of the sweat glands which causes bumps that look like pimples to form on the skin. Depending on the type of syringoma, it can appear as yellow, brown or skin-coloured spots and is usually found on the face, especially around the eyes, but can occur anywhere on the body where there are sweat glands. Syringoma can affect anyone but is more common in women than in men and affects early adolescents going through puberty and adults over 40 years. 

Syringoma has no risk to patients, and does not require treatment, but there are several treatments available that can remove the spots from the face. There is no definite prevention of syringoma, but reducing stress, controlling blood sugar if you are diabetic and wearing sunscreen can reduce the chance of developing syringoma. Taking care of your skin is the best way to prevent formation of syringomas.