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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 23  |  Issue : 1  |  Page : 52-54

Apocrine hidrocystomas: An unusual case presentation and review of literature


Department of Dermatology, King Abdulaziz Hospital, Mecca, Saudi Arabia

Date of Web Publication25-Jan-2019

Correspondence Address:
Dr. Khalid Ali Al Hawsawi
Department of Dermatology, King Abdulaziz Hospital, Mecca
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdds.jdds_55_18

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  Abstract 


Apocrine hidrocystomas (AHs) are cystic benign lesions of the skin that originates from the apocrine sweat glands. It is usually solitary and occasionally multiple. Herein, we report an unusual case of multiple apocrine hidrocystomas. A 65-year-old Saudi male patient presented with asymptomatic recurrent skin lesions on his face for 2 years. The skin lesions appear during hot weather and regress in cooler temperatures. Skin examination revealed multiple skin-colored papules around both the eyes. Skin biopsy showed normal epidermis. The dermis showed cystic structure lined by columnar epithelium with decapitation secretion and some apical snouts. Based on the above clinicopathological findings, the diagnosis of AHs was made. The patient was reassured.

Keywords: Apocrine hidrocystomas, cystadenoma, sudoriferous cyst


How to cite this article:
Al Hawsawi KA, Assaedi LM, Gefri A, Bukhari R. Apocrine hidrocystomas: An unusual case presentation and review of literature. J Dermatol Dermatol Surg 2019;23:52-4

How to cite this URL:
Al Hawsawi KA, Assaedi LM, Gefri A, Bukhari R. Apocrine hidrocystomas: An unusual case presentation and review of literature. J Dermatol Dermatol Surg [serial online] 2019 [cited 2019 Nov 14];23:52-4. Available from: http://www.jddsjournal.org/text.asp?2019/23/1/52/250836




  Introduction Top


Hidrocystoma is a benign cystic lesion of the skin that originates from the sweat glands.[1] There are two types of hidrocystoma: eccrine and apocrine. The lesions that appear along the lower eyelid margin are called Moll's gland cysts.[2] The exact etiology is unknown. However, it is believed that eccrine hidrocystoma is due to the retention of eccrine secretions leading to cystic dilation of eccrine ducts, whereas apocrine hidrocystomas (AHs) are thought to be due to adenomas of the apocrine sweat gland [Table 1].[3],[4],[5],[6]
Table 1: Differentiations between eccrine and apocrine hidrocystomas

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AH is often observed on the head (around the eye, particularly lateral to the outer canthus), neck as well as trunk regions.[1],[2] It is less frequently found on the penis, ears, scalp, chest, shoulders, feet, axillae, and anal region.[3],[4] AH presents as asymptomatic skin-colored papules that are 3–15 mm in size. AH is usually solitary but occasionally multiple. It is most common in adults, aged between 30 and 70 years. It affects both genders equally.[1]


  Case Report Top


A 65-year-old Saudi male patient previously healthy presented with an asymptotic recurrent skin lesion on his face for 2 years. The skin lesion was aggravated by heat exposure or in hot weather and regresses in cooler temperatures. There were no similar lesions in the family. Skin examination revealed multiple skin-colored deep-seated vesicular papules around both the eyes [Figure 1]. Skin biopsy showed normal epidermis; in the dermis, there was cystic structure lined by columnar epithelium with decapitation secretion and some apical snouts [Figure 2]. Based on the above-mentioned clinicopathological findings, the diagnosis of AHs was made. The patient was reassured.
Figure 1: Multiple skin-colored tiny cystic papules around the eye

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Figure 2: Histopathology of the skin lesions. The epidermis is normal. (a) The dermis shows cystic structure. (b) The cyst is lined by columnar epithelium with decapitation secretion and some apical snouts

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  Discussion Top


AHs are a benign cystic lesions of the skin that originates from the apocrine sweat glands.[1] The main differential diagnosis in our case includes senile comedones (Favre–Racouchot syndrome), vellus hair cysts, fibrofolliculoma, and syringomas. However, the histopathology was typical for apocrine hidrocystomas. Our patient showed unusual presentation of apocrine hidrocystomas, in term of multiple lesions and seasonal variation. Although the seasonal variations are a known feature of eccrine hidrocystomas, there was a single report of seasonal variations associated with multiple apocrine hidrocystomas.[7],[8],[9]

Both eccrine and AHs have been reported to be associated with Schopf–Schulz–Passarge syndrome and Goltz–Gorlin syndrome (focal dermal hypoplasia).[10],[11] However, our patient has none of these. Goltz–Gorlin syndrome is usually seen in females and characterized by microcephaly, malformed ears, microphthalmia, papillomas of the lip, tongue, anus, and axilla, linear skin atrophy with telangiectasias, hypo- and hyperpigmented skin lesions that follow  Lines of Blaschko More Details, and mental retardation.[11] Schopf–Schulz–Passarge syndrome is an autosomal recessive syndrome characterized by multiple AHs of the eyelids, associated with palmoplantar hyperkeratosis.[10],[11] About 1% atropine cream has been reported as a successful treatment of eccrine hidrocystomas.[10] Others have reported using electrosurgery and surgical excision as successful treatments of both eccrine and AHs.[12],[13],[14],[15]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sehgal S, Agarwal R, Singh S, Goyal P. Fine-needle aspiration cytology of eccrine hidrocystoma. Cytojournal 2012;9:6.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Warkel RL. Selected apocrine neoplasms. J Cutan Pathol 1984;11:437-49.  Back to cited text no. 2
    
3.
Ter Poorten HJ. Apocrine hidrocystoma of the right scapula. Arch Dermatol 1977;113:1730.  Back to cited text no. 3
    
4.
Alessi E, Gianotti R, Coggi A. Multiple apocrine hidrocystomas of the eyelids. Br J Dermatol 1997;137:642-5.  Back to cited text no. 4
    
5.
Kaur C, Sarkar R, Kanwar AJ, Mohan H. Multiple eccrine hidrocystomas. J Eur Acad Dermatol Venereol 2002;16:288-90.  Back to cited text no. 5
    
6.
Smith RJ, Kuo IC, Reviglio VE. Multiple apocrine hidrocystomas of the eyelids. Orbit 2012;31:140-2.  Back to cited text no. 6
    
7.
Ovhal AG, Deshkulakarani SV, Abhange RS, Birare SD. Rare benign cystic lesions on face: Apocrine hidrocystoma. Indian J Dermatol 2016;61:237.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Vani D, Dayananda TR, Shashidhar HB, Bharathi M, Kumar HR, Ravikumar V, et al. Multiple apocrine hidrocystomas: A case report. J Clin Diagn Res 2013;7:171-2.  Back to cited text no. 8
    
9.
Verma SB. Multiple apocrine hidrocystomas: A confusing clinical diagnosis. An Bras Dermatol 2010;85:260-3.  Back to cited text no. 9
    
10.
McKee P, Calonje E, Granter S. Pathology of the Skin. 3rd ed. St Louis: Elsevier Mosby; 2005. p. 1589-91.  Back to cited text no. 10
    
11.
Sarabi K, Khachemoune A. Hidrocystomas – A brief review. Med Gen Med 2006;8:57.  Back to cited text no. 11
    
12.
Calonje E, MackKie RM. Tumors of the SK in appendages. In: Burns T, Breathnach S, Cox N, Griffitshs C, editors. Rook's Textbook of Dermatology. 5th ed. Vol. 2. Oxford: Blackwell Science; 2004. p. 37.15.4.  Back to cited text no. 12
    
13.
Alfadley A, Al Aboud K, Tulba A, Mourad MM. Multiple eccrine hidrocystomas of the face. Int J Dermatol 2001;40:125-9.  Back to cited text no. 13
    
14.
Gupta S, Handa U, Handa S, Mohan H. The efficacy of electrosurgery and excision in treating patients with multiple apocrine hidrocystomas. Dermatol Surg 2001;27:382-4.  Back to cited text no. 14
    
15.
Tanzi E, Alster TS, Surgery L. Pulsed dye laser treatment of multiple eccrine hidrocystomas: A novel approach. Dermatol Surg 2001;27:898-900.  Back to cited text no. 15
    


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