Intraepidermal Eccrine Duct Research Articles

Three cases of eruptive syringoma with dermoscopic features

Syringoma is a benign adnexal neoplasm originating from the intraepidermal eccrine duct. Eruptive Syringoma (ES) is a rare variant that is characterized by skin-colored to reddish-brown and shiny papules. Here we report three cases of ES, one of them initially misdiagnosed as Darier disease. Dermoscopy showed light brown pigment networks and dotted or linear vessels. All these cases were confirmed as ES by histopathological examination, highlighting the importance of histopathological and dermoscopic evaluation.

Porokeratotic eccrine ostial and dermal duct nevus: A rare case report

Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is an uncommon benign disorder that clinically mimicks comedo nevus but usually favors the palms and soles, where pilosebaceous follicles are absent. It also can present with widespread involvement along Blaschko's lines. It is a disorder of keratinisation involving the intraepidermal eccrine duct (acrosyringium) with classical histopathological examination findings (eccrine hamartoma and cornoid lamellation). The patient is a 32-year-old woman with a 12-year history of pruritic skin lesions on her right palm and index finger. Histopathological examination revealed multiple small epidermal invaginations with overlying parakeratotic cornoid lamellation and loss of granular layer. Few dyskeratotic cells are seen at the base of epidermal invagination. After clinic-pathologic correlation, the diagnosis of PEODDN was made. Late-onset and rare clinical presentation as pruritic lesion are the characteristic features that make this patient an extraordinary presentation of PEODDN.

Dermoscopy Of The Month: Dermoscopic Finding of Pigment Network in Lesions of Eruptive Syringoma

Abstract Syringoma is a benign adnexal tumor derived from intraepidermal eccrine ducts. The usual presentation of syringoma is a small smooth skin-colored, yellowish or brownish papule with flattened or rounded top. Eruptive syringoma is a rarely reported form, where lesions are numerous and occur in successive crops. A case of a 57-year-old Caucasian male with a twenty four-year history of multiple asymptomatic, erythematous and brownish papules, predominantly over the anterior aspect of the trunk is presented. All lesions appeared after prolonged sun exposures within a few days and persisted without further changes afterwards. Contact non-polarized dermoscopy showed a fine light brown, regular pigment network on a light pink background, being the same in all lesions. History of the disease, clinical finding and dermoscopy were inconclusive, and biopsy was performed. Histopathology revealed signs of syringoma. Dermoscopic finding was thought to be intriguing and therefore is discussed in this paper.

Verrucous eccrine poroma of retroauricular region

Eccrine poroma (EP) is a benign neoplasm of sweat glands originating from the terminal intraepidermal eccrine duct. This tumor is generally known to present over acral locations, most commonly over palmar and plantar surfaces; however, it has also been documented on the trunk, face, and neck region. EP over the auricle is rarely reported. We are reporting a 71-year-old male who presented with a mass in the right retroauricular region, which was histopathologically suggestive of EP.

Eccrine Poroma of the Postauricular Area.

Eccrine poroma is a common benign cutaneous tumor that originates in an intraepidermal eccrine duct. This tumor exhibits acral distribution (sole, palm), and is rarely encountered in the head and neck area. In fact eccrine poroma in the postauricular area has only been rarely reported. A 55-year-old female visited our hospital with a main complaint of a mass that first developed in the left postauricular area about a year previously. The mass was painless, soft, protruding, domed, and dark red in color, and had slowly enlarged (at presentation it measured 1×1 cm). Excisional biopsy was performed. Histological examination showed distinct features, and eccrine poroma was diagnosed. Follow-up at 6 months postoperatively showed no recurrence. The frequency of eccrine poroma is dependent on eccrine sweat glands density, and thus, usually occurs on the palms or soles. For eccrine poroma in the head and neck region, the differential diagnosis must rule out other masses, such as nevus, skin tag, pyogenic granuloma, cyst, basal cell carcinoma, and seborrheic keratosis. Importantly, 18% of poromas show malignant transformation, and can develop into porocarcinoma. For these reasons, an eccrine poroma in the facial area requires histological examination, complete excision, and follow-up.

Cutaneous syringoma: A clinicopathologic study of 34 new cases and review of the literature

Background:Syringoma is a benign adnexal tumor derived from intraepidermal eccrine duct.Aim:The aim of the study is to report the experience concerning syringoma by reviewing the clinical and histopathologic features of a series of 34 histologically diagnosed syringoma patients observed over a period of six years.Materials and Methods:Thirty-four patients were sorted into two groups, localized and generalized syringoma, according to the Friedman and Butler classification. Different histopathologic findings were recorded in specially designed questionnaires for further analysis.Results:Ninety-seven percent of the patients were females with the mean age of 27.6 years. The mean duration of the lesions before the presentations was six years. The diagnosis of syringoma was only considered in 23 patients (67.6%) and was the initial diagnosis in only 13 (38.2%) patients. All histological findings were seen more common in our cases. in comparison to the documented cases in the literature. Clear cell change of epithelial eccrine cells was 85.2% and there was no difference in the histopathological findings in the two groups. Our patients with generalized syringoma (GS) had a considerable lower age of onset than the ones with localized syringoma (LS) (P = 0.027).Conclusion:Our patients with generalized syringoma were younger than the ones with localized syringoma. Distribution of the generalized syringoma was mainly in the chest and neck followed by the forearms whereas localized syringoma was mostly confined to the face, axilla and genitalia. There were also some conditions associated with our cases including sarcoidosis, calcinosis cutis and basal cell carcinoma.

Porokeratotic Eccrine Ostial and Dermal Duct Nevus

PEODDN is a rare benign cutaneous disorder that clinically resembles comedo nevus but favors the palms and soles, where pilosebaceous follicles are absent. Widespread involvement along Blaschko's lines can also occur. It is a disorder of keratinization involving the intraepidermal eccrine duct (acrosyringium) and is characterized by eccrine hamartoma and cornoid lamellation in pathology. The patient is a 29-year-old man with an 8-year history of pruritic skin lesions on his right lateral ankle. In the pathologic examination, multiple small epidermal invagination with overlying parakeratotic cornoid lamellation, loss of granular layer, and few dyskeratotic cells at the base of epidermal invagination are revealed. After clinic-pathologic correlation, the diagnosis of porokeratotic eccrine ostial and dermal duct nevus (PEODDN) was made. Late-onset and rare clinical presentation as pruritic lesion are the characteristic features that make this patient an extraordinary presentation of PEODDN.

Successful Reconstruction After Resection of Malignant Eccrine Poroma Using Retroauricular Artery Perforator-Based Island Flap

Malignant eccrine poroma (MEP), or porocarcinoma, is a rare malignant tumor arising from the intraepidermal eccrine duct. It has propensity to arise on the lower limbs (44%), trunk (24%), or head and neck region (24%) but rarely occurs on the scalp. It is very difficult to find proper technique for the first time. In this paper, we introduce rare MEP developing in a longstanding eccrine poroma on the scalp (postauricular area) and successful reconstruction method using perforator-based island flap. A 52-year-old man who had an abrupt growth of a mass on the temporal area presented to us. It was a 3.7 × 2.1-cm mass with fungated margin, but it does not involve the perivertebral muscle and fat tissues in computed tomography scan. The next we executed was general operation for wide excision and scalp reconstruction of a large postauricular defect using retroauricular artery perforator-based island flap. We harvested 7 × 5 cm sized flap and donor site closed primarily without any skin graft. We found that the flap had mild congestion after the suture and mild fullness because of swelling. Retroauricular artery perforator-based island flap can survive over the bone, protect the infection, and bear the radiological treatment. Aesthetically, the patient was very satisfied with the result: similar skin texture, color, thickness, and pliability. There was only a linear scar on the lower margin of the mandible.

Rare sweat gland tumors of vulva: Report of two cases

Syringomas and Fox-Fordyce disease are appendageal skin disorders. While syringomas represent an adenoma of the intraepidermal eccrine duct, Fox Fordyce disease occurs due to blockage of the apocrine sweat duct. In both conditions, extragenital sites are more frequently involved than the genitalia. We herein report two young females, one with syringomas on the face and vulva and the other with Fox Fordyce disease involving axilla, areola and vulva, thereby citing the importance of examination of genitalia in these disorders.

An Infrequent Case of Neoplasm With Fibroepithelioma of Pinkus and Hidradenomatous Features Arising at the Umbilicus: A Rare Finding

An Infrequent Case of Neoplasm With Fibroepithelioma of Pinkus and Hidradenomatous Features Arising at the Umbilicus: A Rare Finding

A Case of Clear Cell Eccrine Porocarcinoma

Eccrine porocarcinoma (EP) is a rare malignant tumor arising from the intraepidermal eccrine duct. The tumor cells frequently contain glycogen, but prominent clear cell changes in EP are rarely reported. A 78-year-old woman presented with a slightly pruritic, erythematous, verrucous plaque on her left thigh. Histopathological examination revealed intraepidermal tumor cell nests composed of small basaloid cells and duct-like structures lined by periodic acid-Schiff (PAS)-positive cuticles. Besides the typical findings of EP, clear cell changes were predominantly observed in the tumor cell aggregations. Herein we report a case of the clear cell variant of EP rarely reported in previous literature.

Porokeratotic Eccrine Ostial and Dermal Duct Nevus: A Report of 2 Cases and Review of the Literature

Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is a rare disorder of keratinization involving the intraepidermal eccrine duct (acrosyringium). We detail two examples of this unique clinicopathological entity--one with a more typical clinical presentation and one with a solitary lesion and late adult onset. In addition, we discuss the distinctive histologic and immunohistochemical findings and review the literature.

Whitish papules on the palm

A 21-year-old woman presented with a 1-month history of whitish bubbling of the palms after brief exposure to water. The symptoms arose within 3-5 min after immersion in water, as a white sponge-like appearance, and resolved after a variable drying period. She was otherwise healthy and did not complain of hyperhidrosis. There was no family history of similar lesions. Physical examination revealed a healthy appearance of the palms; however, 5 min after immersion of the hands in warm water, the central part of the left palm became swollen and tiny white papules with dilated puncta appeared. The right palm also showed similar changes. These asymptomatic papules with a tendency to coalesce became more prominent with prolonged exposure (Figs 1 and 2). The lesions resolved completely approximately 30 min after removal of the hands from water. A biopsy taken from the lesional skin revealed dilatation of intraepidermal eccrine ducts and a spongy appearance in the corneal layer (Fig. 3). A diagnosis of aquagenic syringeal palmar keratoderma was made on the basis of these clinical and histopathologic findings. A short course of treatment with topical aluminum chloride resulted in a remarkable response in 1 week. She had no recurrence after 1 year.

Pinkus tumor may originate from intraepidermal eccrine ducts and proliferate in the dermis

To clarify the histopathogenesis of Pinkus tumor (fibroepithelial basal cell carcinoma, FEBCC), we have studied cytokeratin (CK) expression in FEBCC using ten different anti-keratin antibodies against CK 1, 7, 8, 10, 14, 15, 16, 17, 18 and 19. Tumor nests consisted of two epithelial components: duct-like structures and basaloid cells of anastomosing strands. In duct-like structure, CK 1, 10, 14, 16, 17 and 19 were detected. CK expression of duct-like structure showed the hyperproliferative state of eccrine intraepidermal ducts. In basaloid cells of anastomosing strands, CK 14 and 17 were detectable. These results suggested that duct-like structure originates from the intraepidermal duct and proliferates to spread in the dermis.

Sudoriferous acrosyringeal acantholytic disease

Three selected cases of transient acantholytic dermatosis were studied because of their definitive correlation with sweating due to fever and/ or bed-ridden situations. Biopsy specimens were serially sectioned and acantholysis was found in the acrosyringium or traced to connect to the acrosyringium in all biopsy specimens. Carcinoembryonic antigen (CEA) and eccrine gland-specific monoclonal antibody, IKH-4, were positive in acantholytic cells. Electron microscopy revealed electron dense material filling the lumen of intraepidermal eccrine ducts. This material leaked into lateral intercellular spaces of the luminal cells, passing tight junctions. Marked edema and numerous lysosomes were reminiscent of those found when eccrine acrosyringium is formed in the embryo; this suggested that an occluded and damaged eccrine intraepidermal duct was being rebuilt via lysosomal digestion.

Differentiation-Associated Localization of nPKCμ, a Ca++-Independent Protein Kinase C, in Normal Human Skin and Skin Diseases

The expression of nPKC eta, a Ca(++)-independent isoform of protein kinase C in normal human skin, and skin from patients with psoriasis, squamous cell carcinoma, basal cell epithelioma, nevus pigmentosus, and seborrheic keratosis, were examined by immunohistochemical staining using a polyclonal antibody raised against a synthetic peptide at a diverse region of the nPKC eta molecule. In normal epidermis, the strongest staining was observed in the uppermost granular layer with no staining of the spinous or basal layers. The inner layer of the intra-epidermal eccrine duct was also strongly stained. Weak staining was observed in several layers of the outer root sheath of the follicular infundibulum. No staining was detected in the inner root sheath of the hair follicles, hair matrix, sebaceous gland, eccrine gland, intradermal eccrine duct, arrectores pilorum, melanocytes, Langerhans cells, fibroblasts, or blood vessels. In psoriatic skin, stained keratinocytes were distributed in the suprabasal layers with the most being observed in the uppermost layer and the least in layers closed to the basal layer. In squamous cell carcinoma, weak staining was observed in the keratotic cells around horny pearls. In the basal cell epithelioma and nevus pigmentosus, the cells were not stained, whereas in seborrheic keratosis, cells that stained were located in the granular layer. We conclude from the evidence presented above that nPKC eta is expressed in close association with epidermal differentiation in normal skin and skin diseases.

Hidroacanthoma simplex showing variation in the appearance of tumor cells in different nests

We report a case of hidroacanthoma simplex on the inframammary area of an 86-year-old woman. The tumor cells showed considerable variation in appearance in different nests from the same lesion. By light and electron microscopy 5 types of tumor cells were identified. This tumor was thought to originate from the outer cells of the intraepidermal eccrine duct.

An Unusual Case of Preponderantly Right-Sided Syringomas

Syringomas are fairly common, benign, appendageal tumors that are believed to represent tumors of intraepidermal eccrine ducts. 1,2 Multiple lesions on the trunk have been reported as a rare type of syringoma under the name hidradenoma. 3 An unusual case of eruptive syringomas occurred on the trunk and extremities, with a preponderantly right-sided distribution. Report of a Case A 7-year-old boy was seen in 1971 with a two-month history of a skin eruption. On examination, there were pinpoint-sized, hypopigmented to flesh-colored, shiny, grouped papules on the inner aspects of the right thigh, right side of the lower part of the abdomen, and the right forearm (Fig 1). The patient did not return until 1978, when, at the age of 14 years, he had multiple new lesions on the right lower extremity. Many additional papules were present on the right thigh, abdomen, and forearm. There were only a few scattered

Studies on topical antiperspirant control of axillary hyperhidrosis

Axillary hyperhidrotics is reviewed from the standpoint of anatomical factors, physiological mechanisms and the history of methods of control. Anhydrous aluminum chloride and anhydrous zirconium tetrachloride are shown to be superior topical agents for partial control of axillary sweating when applied as a powder or in anhydrous nonreactive vehicles. Complete anhidrosis as demonstrated by sustained garment armpit dryness could be achieved in hyperhidrotics within 48 hours by the following trinary antiperspirant system: (1) a saturated solution of aluminum chloride hexahydrate or zirconyl chloride in absolute ethanol or isopropyl alcohol, (2) application to the dry axilla at times of sleep or other prolonged non-sweating period, (3) water vapor occlusion of area for 6 to 8 hours by means of Saran wrap. The hypothesis is presented that metallic antiperspirants act by reflux entrance into the terminal intraepidermal eccrine duct, slowly combining with the intraductal keratin, to produce a fibrillar contraction (super contraction) of keratin and hence functional closure, not histologically evident. This altered keratin is shed weeks later, with the consequent return of ductal patency and sweating.

Studies on topical antiperspirant control of axillary hyperhidrosis.

Axillary hyperhidrotics is reviewed from the standpoint of anatomical factors, physiological mechanisms and the history of methods of control. Anhydrous aluminum chloride and anhydrous zirconium tetrachloride are shown to be superior topical agents for partial control of axillary sweating when applied as a powder or in anhydrous nonreactive vehicles. Complete anhidrosis as demonstrated by sustained garment armpit dryness could be achieved in hyperhidrotics within 48 hours by the following trinary antiperspirant system: (1) a saturated solution of aluminum chloride hexahydrate or zirconyl chloride in absolute ethanol or isopropyl alcohol, (2) application to the dry axilla at times of sleep or other prolonged non-sweating period, (3) water vapor occlusion of area for 6 to 8 hours by means of Saran wrap. The hypothesis is presented that metallic antiperspirants act by reflux entrance into the terminal intraepidermal eccrine duct, slowly combining with the intraductal keratin, to produce a fibrillar contraction (super contraction) of keratin and hence functional closure, not histologically evident. This altered keratin is shed weeks later, with the consequent return of ductal patency and sweating.