Dermatology: Practical and Conceptual Image Letter | Dermatol Pract Concept. 2025;15(2):5230 1 Reactive Eccrine Syringofibroadenoma Associated with Neuropathy and Diabetic Foot Ulcer Yusuf Can Edek1, Hale Nur Ertugay Aral1, Meral Toker2, Betül Öğüt2, Esra Adışen1 1 Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey 2 Department of Pathology, Gazi University Faculty of Medicine, Ankara, Turkey Key words: Reactive eccrine syringofibroadenoma, Adnexal tumors of skin Citation: Edek YC, Aral HNE, Toker M, Ogut B, Adisen E. Reactive Eccrine Syringofibroadenoma Associated with Neuropathy and Diabetic Foot Ulcer. Dermatol Pract Concept. 2025;15(2):5230. DOI: https://doi.org/10.5826/dpc.1502a5230 Accepted: February 10, 2025; Published: April 2025 Copyright: ©2025 Edek et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Ethics Statement: The patient in this manuscript has given written informed consent to the publication of her case details. Corresponding Author: Yusuf Can Edek. Address: Gazi Universitesi Tip Fakultesi Hastanesi, Emniyet Mahallesi, Mevlana Bulvari, No: 29, 06560 Ankara/ Turkey. ORCID ID: 0000-0002-3877-8681. E-mail: yusuf-can-35@hotmail.com Case Presentation A 67-year-old female patient presented to our department with a leg ulcer on the left foot. Her medical history revealed pal- moplantar pustular psoriasis, hypertension, and type 2 diabetes with neuropathy and nephropathy. Dermatological examination showed a sharply demarcated ulcer on the dorsum of left foot; multiple cobblestone-like flesh-colored nodules on the dorsum of the foot were also observed. Pink lacunae separated by white septa were seen in the dermoscopic analysis (Figure 1A-C). Histopathological analysis of the nodules showed a lesion con- sisting of anastomosing epithelial cords on a fibrovascular base forming a “lattice-like” pattern and duct-like structures within the anastomosing cords (Figure 1D-F). Eccrine syringofibroade- noma (ESFA) diagnosis was made, and the patient was accepted as having reactive ESFA due to the acral location of the lesion accompanying diabetic neuropathy and foot ulcer. Teaching Point ESFA is a rare adnexal tumor of eccrine ductal differentia- tion that often appears as a solitary, hyperkeratotic nodular lesion with a tendency in the extremities. Reactive ESFA is associated with inflammatory or neoplastic dermatosis and frequently occurs in the acral location. Burn scar, bullous pemphigoid, erosive lichen planus, lymphedema, squamous cell carcinoma, psoriasis, diabetes mellitus with polyneu- ropathy, and chronic ulcer can trigger reactive changes that may be associated with eccrine duct remodeling or re- pair. Although ESFA may regress spontaneously, treatment is recommended due to the risk of malignancy. Treatment options include surgery, radiotherapy, imiquimod, and 5- fluorouracil [1,2]. 2 Image Letter | Dermatol Pract Concept. 2025;15(2):5230 References 1. Alli N, Polat M, Cinar SL, Kulaçoğlu S. Eccrine syringofibro- adenoma. Eur J Dermatol. 2008 Jul-Aug;18(4):478-9. DOI: 10.1684/ejd.2008.0463. Epub 2008 Jun 23. PMID: 18573740. 2. Temnithikul B, Jerasutus S, Sudtikoonaseth P, Voravutinon N, Kootiratrakarn T, Kattipathananpong P. Eccrine syringofibroad- enoma (ESFA): a report of two cases. Dermatol Pract Concept. 2016 Jan 31;6(1):5-8. DOI: 10.5826/dpc.0601a03. PMID: 26937300; PMCID: PMC4758438. Figure 1. (A) Multiple cobblestone-like flesh-colored nodules on the dorsum of the left foot, (B) sharply demarcated ulcer on the dorsum of the left foot. (C) Dermoscopic analysis of the lesions showed pink lacunae separated by white septa. (D) A lesion consisting of anastomos- ing epithelial cords on a fibrovascular base and forming a “lattice-like” pattern is observed (H&E x40). (E) Duct-like structures within the anastomosing cords (H&E: x200). (F) Basophilic cuboidal lesion cells smaller in size than surrounding keratinocytes (H&E: x200).