Syringoma is mistaken for xanthelasma
Syringoma
Aetiology
- Relatively common, benign tumor of the sweat glands.
- More common in women.
- Develop in puberty or adult life.
- Occasionally associated with Down’s, Marfan’s and Ehlers-Danlos syndromes.
- A family history of the condition.
Presentation
- Skin-colored or yellowish, rounded or flat-topped papules, up to 3mm in size.
- Usually in clusters on the upper part of the cheeks and lower eyelids.
- Sometimes seen elsewhere, such as the axilla, chest, abdomen or genital areas
Management
- Treatment unnecessary but sometimes requested on cosmetic grounds.
- Large numbers of lesions may be more troublesome to treat.
- Electric needle inserted into the lesion and burst of low-voltage electricity to destroy the lesion. Effective and minimal scarring.
- Surgical excision.
- Cryotherapy.
- Carbon dioxide laser ablation.
- Trichloracetic acid.
- Once destroyed, recurrence is unlikely.
Xanthelasma
Aetiology
- Often occurs in patients with hyperlipidaemia, but can occur in patients with normal lipid levels.
- More common in the 30-50 age range and in women.
Presentation
- Soft, flat yellow plaques – occasionally calcareous.
- Usually occur on the medial side of the upper eyelids.
- Often symmetrically placed.
- May remain static or grow in size but does not regress.
- The function of the eyelid is not normally affected but occasionally ptosis develops.
- Those with xanthelasma and corneal arcus have increased risk of ischaemic heart disease.
Management
- Check fasting lipids and exclude diabetes.
- Treat any underlying problem.
- Treatment not necessary but sometimes requested by patients for cosmetic reasons.
- Surgical excision.
- Chemical cauterisation with trichloracetic acid – may lead to minimal scarring.
- Cryotherapy – may require several treatments and may lead to scarring.
- Carbon dioxide and argon laser treatment – may cause pigmentation and scarring.