Eccrine Hidrocystoma

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INTRODUCTION Eccrine hidrocystoma represents a common cystic lesion with a lining that resembles that of eccrine sweat glands. Thought to represent ductal retention cysts, they occur commonly on the face with a predilection for the canthal angles. Immunohistochemical studies suggest that these lesions are of eccrine origin.

CLINICAL PRESENTATION Such lesions present as solitary or multiple, small translucent 1 to 5 mm fluid filled cysts. The lesions are typically flesh-colored to bluish, tense shiny vesicles usually near the eyelid margins. They are located in the dermis and the overlying epidermis is uninvolved. They tend to increase in size in hot, humid weather associated with increased perspiration. When the cyst wall is punctured the cyst collapses and exudes a clear thin fluid and there is no evidence of layered debris from cellular decapitation as with apocrine cysts.

Sudoriferous Cyst

HISTOPATHOLOGY Two layers of epithelium line these unilocular cysts, commonly termed sudoriferous cysts by ophthalmologists. The inner layer is cuboidal and the outer layer is usually low cuboidal to flat. The cyst contents are often absent from histological sections; when present, there is lightly eosinophilic proteinaceous material.

Sudoriferous Cyst Histology

DIFFERENTIAL DIAGNOSIS The differential diagnosis includes apocrine hidrocystoma, milia, pilar cyst, epidermal inclusion cyst, and syringoma.

TREATMENT When removal is desired, complete surgical excision including the cyst wall is the treatment of choice. Pulsed dye laser ablation has been reported to give good results after multiple treatment sessions. Botulinum toxin has been suggested as an alternative therapeutic option because of its effect on reducing sweat production.

REFERENCES

Alfadley A, Al Aboud KA, Tulba A, Mourad MM. Multiple eccrine hidrocystomas of the face. Int J Dermatol 2002; 40:125-129. Blugerman G, Schavelzon D, D'Angelo S. Multiple eccrine hidrocystomas: a new therapeutic option with botulinum toxin. Dermatol Surg 2003; 29:557-559.

Cordero AA, Montes LF. Eccrine hidrocystoma. J Cutan Pathol 1976; 3:292-293.

DeViragh PA, Szeimes RM, Eckert F. Apocrine cystadenoma, apocrine hidrocystoma, and eccrine hidrocystoma: three distinct tumors defined by expression of keratins and milk fat globulin 1. J Cutan Pathol 1997; 24:249-255. Kaur C, Sarkar R, Kanwar AJ, Mohan H. Multiple eccrine hidrocystomas. J Eur Acad Dermatol Venereol 2002; 16:288-290. Smith JD, Chernosky ME. Hidrocystomas. Arch Dermatol 1974; 109:700-702. Sperling LC, Sakas EL. Eccrine hidrocystomas. J Am Acad Dermatol 1992; 7:763-770.

Tanzi E, Alster TS. Pulsed dye laser treatment of multiple eccrine hidrocystomas: a novel approach. Dermatol Surg 2001; 27:898-900.

Yasaka N, Iozumi K, Nashiro K, Tasuchida T, et al. Bilateral periorbital eccrine hidrocystoma. J Dermatol 1994; 21:490-493.

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