Dermatology: Practical and Conceptual Letter | Dermatol Pract Concept 2021;11(2):e2021022 1 Dermatology Practical & Conceptual Eruptive Syringomas on the Neck: Clinicopathological and Dermoscopic Features Gargi Taneja1, Neirita Hazarika1, Riti Bhatia1 1 Department of Dermatology and Venereology, All India Institute of Medical Sciences, Rishikesh, India Key words: syringomas, eccrine gland neoplasms, neck, eruptive Citation: Taneja G, Hazarika N, Bhatia R. Eruptive syringomas on the neck: clinicopathological and dermoscopic features. Dermatol Pract Concept. 2021;11(2):e2021022. DOI: https://doi.org/10.5826/dpc.1102a22 Accepted: September 8, 2020; Published: March 8, 2021 Copyright: ©2021 Taneja et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License BY- NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: None. Competing interests: The authors have no conflicts of interest to disclose. Authorship: All authors have contributed significantly to this publication. Corresponding author: Riti Bhatia, MD, Department of Dermatology and Venereology, All India Institute of Medical Sciences, Rishikesh, India. Email: ritibhatia_aiims@yahoo.com  Introduction Syringoma is a benign adnexal tumor that originates from the acrosyringium. Eruptive syringoma is a rare variant that mani- fests in the form of skin-colored or brownish, shiny, angulated papules that occur in successive crops. Dermoscopic evaluation reveals brownish regular pigment network and tiny whitish dots between adjacent papules that correspond histologically to multiple eccrine ducts lined by a double-layered epithelium, giving a paisley tie appearance. This case of eruptive syringomas presenting with brownish papules on the neck highlights the importance of histopathological and dermoscopic evaluation.      Case Presentation A woman in her late twenties presented with a 7- to 8-year history of asymptomatic papules on the neck. The papules developed episodically, in clusters (Figure 1). She had no history of chronic disease and no family history of a similar condition. Physical examination revealed multiple monomor- phic brownish papules on the anterior part of the neck and chest. Routine laboratory tests, including lipid profile and serum thyroid hormone levels, were all normal. Figure 1. Multiple monomorphic brownish papules on the neck and upper chest. A 4-mm punch biopsy was obtained from one of the papules. Histopathologic analysis revealed multiple eccrine ducts and solid nests of epithelial proliferation within the Letter | Dermatol Pract Concept 2021;11(2):e2021022 dermis. The ducts were lined by a double-layered epithelium. Amorphous eosinophilic material could be appreciated in some ductal lumina. Some ducts showed small, comma-like extension of epithelial cells. The stroma was collagenous (Figure 2). Dermoscopic evaluation (polarized mode, DermLite) of a papule revealed brownish regular pigment network and tiny whitish dots between adjacent papules (Figure 3). Based on clinical, histopathogical, and dermoscopic features, a diagno- sis of eruptive syringomas was made. Conclusions Syringoma is a benign adnexal tumor that originates from the acrosyringium [1]. The commonest type of syringoma is the localized variant that usually involves the periorbital area. Erup- tive syringoma is a rare variant that manifests around puberty in the form of skin-colored or brownish, shiny, angulated papules that occur in successive crops. Other variants include the familial type and trisomy 21-associated syringoma. Eruptive syringoma usually involves the anterior chest, upper abdomen, axillae, and periumbilical region [1]. It has been reported in association with Down syndrome, prurigo nodularis, sarcoidosis, psychiatric disorders, and Ehlers–Danlos syndrome. Clinical differential diagnoses include steatocystoma multiplex, disseminated xan- thoma, multiple trichoepitheliomas, urticaria pigmentosa, and disseminated granuloma annulare. Histopathological findings include eccrine ductal prolifera- tion in a dense fibrous stroma. There is formation of nests and cords of double-layered epithelial cells. The outer epithelium is often elongated into comma-like structures, resembling a paisley tie pattern. Dermoscopic features include a delicate pigment network and multifocal whitish areas [2]. The pigment network has been attributed to overlying basal hyperpigmenta- tion, more so in the eruptive variant. Whitish dots in between the pigment network corresponds to the opening of eccrine glands, which are larger than those of uninvolved skin [2]. However, dermoscopic features of syringoma are described somewhat variably in the literature. The reticular brown pigmentation may not to be present in all cases, especially in isolated syringoma [3]. Most cases of eruptive syringomas show a fine pigment network with whitish areas, but data is limited due to the sparse literature on this topic [4]. The rosette pattern of whitish dots has also been described in 1 case report [4]. The lesions are benign and usually remain static. Treatment modalities include dermabrasion, excision, electrodesiccation, chemical peeling, and oral and topical retinoids. The outcome is usually unsatisfactory. This case of eruptive syringomas presenting with brownish papules on the neck highlights the importance of histopathological and dermoscopic evaluation.      References 1. Pruzan DL, Esterly NB, Prose NS. Eruptive syringoma. Arch Dermatol. 1989;125(8):1119-1120. DOI: 10.1001/archderm .1989.01670200095017. PMID: 2547344. 2. Ankad BS, Sakhare PS, Prabhu MH. Dermoscopy of non-melanocytic and pink tumors in brown skin: a descriptive study. Indian J Derma- topathol Diagn Dermatol. 2017;4(2):41-51. DOI: 10.4103/ijdpdd. ijdpdd_10_17. 3. Corazza M, Borghi A, Minghetti S, Ferron P, Virgili A. Dermoscopy of isolated syringoma of the vulva. J Am Acad Dermatol. 2017;76(2S1): S37-S39. DOI: 10.1016/j.jaad.2016.06.009. PMID: 28087025. 4. Zhong P, Tan C. Dermoscopic features of eruptive milium-like syringoma. Eur J Dermatol. 2015;25(2):203-204. DOI: 10.1684/ ejd.2014.2506. PMID: 25961748.  Figure 2. Lesional biopsy shows multiple eccrine ducts and solid nests of epithelial proliferation with comma-like structures, resem- bling a paisley tie pattern (H&E, ×400). Figure 3. Dermoscopic image (polarized mode, DermLite) of the papule shows regular brownish pigmented network (circle) and mul- tiple tiny white dots (black arrow).