[Generalized syringoma: a case study].

efficacy. These lesions are rarely selflimiting, and recurrences are common. We describe a 25-year-old woman with no relevant history who consulted for asymptomatic, flesh-colored papules of 1-2 mm, distributed on the anterior area of the neck and neckline (Figure 1). The symptoms started 10 years earlier on the lower eyelids, gradually spreading to the abdomen, neck, and neckline, with outbreaks after periods of sun exposure. Histological study with hematoxylineosin showed an epithelial growth in the superficial and middle dermis, composed of cells with a pale eosinophilic cytoplasm and rounded, monomorphous nuclei. The cells were arranged in tubules and solid nests, some with a tadpole shape. The neoplasm showed a sclerotic stroma (Figure 2). The diagnosis based on clinical presentation and pathology was generalized syringomas. The patient was informed of the possible therapeutic options, initially choosing to refrain from treatment. Syringomas are uncommon neoplasms, described mainly in women before and during puberty, probably in relation to the presence of hormone receptors and the fact that dermatology consultation for cosmetic purposes is more common among women. They manifest as firm, rounded, pale pink or yellow-colored papules of 1-3 mm diameter. Syringomas have traditionally been classified according to site and form of onset on eyelids, the most common, and eruptive.1 In 1987, Friedman and Butler2 attempted to classify the multiple sites and described 4 clinical forms (Table): localized, familial, Down syndrome-associated, and generalized. Generalized syringomas included a multifocal form and another, more common, eruptive form. The eruptive form, described by Jaquet and Darier in 1887 as “eruptive hidradenoma,” is characterized by outbreaks of papular elements in the anterior and lateral region of the neck, trunk, axillae, abdomen, genital area, and limbs between 4 and 10 years of age. It has been related to heat stimuli.3 Eruptive syringomas have been associated with Down syndrome, palpebral syringomas with Marfan and Ehlers-Danlos syndromes, and syringomas presenting with milia and atrophoderma vermiculata have been associated with Nicolau Balus syndrome. Cases of familial inheritance and others related to diabetes, alopecia,4 and tumors, such as carcinoids,5 have also been reported. There are atypical presentations such as unilateral forms,6 urticaria pigmentosa, or milia. To the Editor: