Dermatology: Practical and Conceptual Observation | Dermatol Pract Concept 2015;5(1):17 87 DERMATOLOGY PRACTICAL & CONCEPTUAL www.derm101.com Case presentation A 33-year old male presented with a 6-year history of brown- ish plaques on both legs. His medical and family histories were unremarkable. The patient reported that the plaques were occasionally painful and that the lesions produced more sweat than the surrounding skin. The patient also reported that there was no trauma preceding the appearance of the lesions. Dermatological examination showed brown- ish indurated plaques at the medial sides of the bilateral popliteal fossa and posterior of the right leg (Figure 1). The plaques were painful upon palpation. The starch-iodine test was performed to determine the presence of hyperhidrosis. To perform this test the plaque on the patient’s right leg was painted with iodine solution and allowed to dry thoroughly. Then, a starch powder was sprinkled on the surface and the appearance of purple-black speckling was observed, indicat- ing presence of hyperhidrosis. Next, an incisional biopsy specimen was obtained from the same lesion. Hematoxylin- eosin (H&E) staining of the biopsy specimen showed lobules with mucinous stroma in the deep dermis and subcutaneous tissue (Figure 2). The lobules were composed of hyperplastic and proliferated eccrine glands, and numerous small blood vessels (Figure 3). With the clinical and histopathological findings, a diagnosis of eccrine angiomatous hamartoma (EAH) was made. Multiple painful brownish plaques associated with local hyperhidrosis Nilay Duman1, Gül Erkin2, Nilgün Atakan2, Özay Gököz3 1 Afyon Kocatepe University, School of Medicine, Department of Dermatology, Afyonkarahisar, Turkey 2 Hacettepe University, School of Medicine, Department of Dermatology, Ankara, Turkey 3 Hacettepe University, School of Medicine, Department of Pathology, Ankara, Turkey Key words: hyperhidrosis, eccrine gland, hamartoma Citation: Duman N, Erkin G, Atakan N, Gököz, Ö. Multiple painful brownish plaques associated with local hyperphidrosis. Dermatol Pract Concept 2015;5(1):17. doi: 10.5826/dpc.0501a17 Received: July 18, 2014; Accepted: October 2, 2014; Published: January 30, 2015 Copyright: ©2015 Duman et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted 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. All authors have contributed significantly to this publication. Corresponding author: Nilay Duman, MD, Assistant professor, Afyon Kocatepe University, School of Medicine, Department of Dermatolology, Ali Çetinkaya Kampusü, İzmir Karayolu 7. Km, Afyonkarahisar, Turkey. Tel. 90 (272) 4440304; Fax. 90 (272) 2463322. E-mail:nilybayram@hotmail.com Eccrine angiomatous hamartoma is a rare hamartomatous lesion characterized by proliferation of ec- crine glands and small blood vessels, and occasionally other elements. It generally arises congenitally or later in childhood, as solitary or multiple lesions on the distal extremities. Adult-onset multiple lesions are very rare. Herein we describe a 33-year-old male with symptomatic multiple eccrine angio- matous hamartoma lesions. ABSTRACT 88 Observation | Dermatol Pract Concept 2015;5(1):17 As EAH is a benign, slow-growing lesion, aggressive treatment is not indicated. Simple excision is currently the treatment of choice in patients with undesirable symptoms, such as pain or hyperhidrosis, those with cosmetic concerns, and in cases of progressive enlargement of the lesions [2]. Botulinum toxin may be considered to treat lesions associated with hyperhidrosis [2]. As the lesions in the presented patient were symptomatic, they were excised. In conclusion, EAH is a rare entity with a unique clinical and histopathological presentation that should be consid- ered in the differential diagnosis of vascular and hamarto- matous lesions. References 1. Naik V, Arsenovic N, Reed M. Eccrine angiomatous hamartoma: a rare multifocal variant with features suggesting trauma. Dermatol Online J 2009;15(9):6. PMID: 19930993 Conclusion EAH is a rare hamartomatous lesion characterized by pro- liferation of eccrine glands and small blood vessels, and occasionally other elements, such as adipose tissue, hair, and epidermis [1,2]. EAH generally occurs congenitally or later in childhood as solitary or multiple lesions on the distal extremi- ties, especially the legs; however, pubertal- and adult-onset lesions, and trunk and head involvement were also reported [3,4]. To date, a gender predilection has not been reported. The clinical presentation of EAH ranges from a simple angioma- tous nodule to erythematous-purpuric plaques. It is generally asymptomatic, but occasionally can be associated with pain and hyperhidrosis, and less frequently hypertrichosis [1,4]. The etiopathogenesis of EAH remains unknown. Some researchers have suggested that faulty interaction between differentiating epithelium and the underlying mesenchyme gives rise to abnormal proliferation of adnexal and vascular structures in congenital forms. Late onset lesions have been associated with recurrent trauma [2]. Histopathological examination of EAH is usually characterized by a circum- scribed, non-encapsulated lobular lesion in the mid to deep dermis that is composed of mature-looking and occasionally dilated eccrine glands, and associated benign vascular prolif- eration. The vascular component is composed of small blood vessels exhibiting variable dilatation. Occasionally, mucinous change, a lipomatous component, or pilar structures are observed [4]. The epidermis is usually normal, but occasion- ally verrucous changes are present. EAH must be differentiated from vascular malforma- tions, tufted angioma, smooth muscle hamartoma, glomus tumor, blue rubber bleb nevus, and macular telangiectatic mastocytosis [3]. Definitive diagnosis of EAH is based on clinicopathological correlation. Figure 1. Brownish indurated plaque at the medial side of the popli- teal fossa. (Copyright: ©2015 Duman et al.) Figure 2. Proliferative lobules with mucinous stroma in the deep dermis and subcutaneous tissue (H&E, x10 original magnification). (Copyright: ©2015 Duman et al.) Figure 3. Proliferative eccrine glands and small blood vessels within the mucinous stroma (H&E, x40 original magnification). (Copy- right: ©2015 Duman et al.) Observation | Dermatol Pract Concept 2015;5(1):17 89 4. Calonje E, Brenn T, Lazar A, et al. Tumors of the sweat glands. In: Calonje E, Brenn T, Lazar A, Mckee PH, eds. Mckee’s Pathology of the Skin. 4th ed. China: Elsevier-Saunders, 2012:1529-30. 2. Lin YT, Chen CM, Yang CH, Chuang YH. Eccrine angiomatous hamartoma: a retrospective study of 15 cases. Chang Gung Med J 2012;35(2):167-77. PMID: 22537932 3. Shin J, Jang YH, Kim SC, Kim YC. Eccrine angiomatous hamar- toma: a review of ten cases. Ann Dermatol 2013;25(2):208-12. PMID: 23717013