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Syringoma is a common but refractory benign skin tumor. Conventional treatment, such as ultra-pulsed carbon dioxide (CO2 ) laser or cryotherapy, often requires multiple treatment and can easily cause prolonged erythema, scarring, or depression, which are frustrating, so there is an urgent need to seek a safer and more effective method. In this article, we tried to demonstrate the Er:YAG laser combined with botulinum toxin A (BTXA) as a safer and more efficacious method for treating syringomas.
METHODS: Twenty-one patients with local syringomas were treated with erbium laser ablation. Immediately after laser treatment, approximately 10 units of BTXA were sprayed on the wound for 10 min.
RESULTS: In total, 21 patients underwent 1.62 ± 0.74 treatments; their Periorbital Syringoma Severity Index (PSSI) score declined from 4.19 (before treatment) to 1.10 (after treatment), and the number of treatments was significantly lower than those reported in previous literature using the erbium laser alone.
CONCLUSIONS: The Er:YAG laser combined with botulinum toxin A for the treatment of syringoma is a safer and more effective treatment than traditional treatment methods.

BACKGROUND: Eruptive syringomas is a rare variant of syringoma, which is a benign adenoma differentiated from the terminal ducts of the eccrine glands. Nowadays, it\'s widely valued because of obvious skin lesions, large scope of influence, and high misdiagnosis rate.
OBJECTIVE: We aim to explore the clinical features of eruptive syringomas and the current research progress.
METHODS: We firstly summarized the clinical features of 90 cases of eruptive syringomas. Then, the chi-square test was used to analyze the relationship between the onset site of eruptive syringomas and age, as well as gender. Finally, we briefly reviewed the previous literature.
RESULTS: During 12 years, 90 cases of eruptive syringomas were diagnosed in our hospital, including 28 males (31.1%) and 62 females (68.9%). The average diagnosed age was 28.8. Patients from 20 to 40 years old is 63 (70%), which is the most. 60 (66.7%) patients had the course for more than 1 year. Among onset sites, the neck, chest, and abdomen were in the top three. The chi-square test showed that there were no significant differences in the onset sites of patients aged ≤ 20 and >20 years old (p-value = 0.181), as well as male and female (p-value = 0.363).
CONCLUSIONS: We found that more female than male was affected, and the most common onset sites were the neck, chest, and abdomen. Neither age nor gender was significantly associated with onset site distribution. Our study provides some data support for the research of eruptive syringomas.

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Objectives: To investigate the application of reflectance confocal microscopy (RCM) imaging in diagnosis of vulva syringoma. Methods: Patients with lesions suspicious of syringoma on vulva were enrolled in the study. After informed consent was taken, the lesions were photographed and imaged with RCM. The features of the lesion in confocal images were then analyzed and compared with the biopsy findings for histology correlation. Results: Eleven cases in total were included in the study. The typical RCM features observed in syringoma are the presence of round to oval high refractive, and relatively monomorphous mass of varying sizes in the superficial and middle dermis, usually surrounded with 1-2 layers of light-dark line structures, which were further confirmed by histological evaluation. Ten cases showed classic features of syringoma and 1 case exhibited milia in RCM images. Conclusions: Syringoma has distinct features in RCM imaging, which correlates well with histological findings, highlighting the potential role of RCM in the diagnosis and differential diagnosis of vulva syringoma.

A 41 years old female patient experienced enlarged right nipple more than 6 years ago. Physical examination showed enlarged and hardened right nipple (about 2 cm) but no tenderness. Mammographic results showed the mixed calcification pattern, which was presenting multiple sizes of circular and granular calcification of the nipple areola complex. Ultrasound revealed large calcification in the nipple areola area with posterior acoustic shadow. This patient underwent extensive excision of the nipple areola complex. The surgical margin was confirmed to be negative. Postoperative pathology confirmed an infiltrating syringomatous adenoma with ossification in some areas. Tumor cell infiltration was not found at the surgical margin. After 4 years of follow-up, no recurrence was found. The mammography and ultrasound findings of this benign tumor were significantly different from those reported in previous literatures. We should improve the understanding of the variousness of clinical imaging manifestations of this disease.

BACKGROUND: In clinical, common facial papule dermatosis such as seborrheic keratosis (SK), verruca plana (VP), syringoma and lichen nitidus (LN) is often misdiagnosed. Summarizing in vivo reflectance confocal microscopy (RCM) features of the facial papule dermatosis is helpful in the diagnosis of ambiguous lesions. The purpose of this study was to evaluate the features of SK, VP, syringoma, and LN in RCM.
METHODS: We recruited 144 patients referred for unequivocal facial papule dermatosis including 60 patients with SK, 60 patients with VP, 10 patients with syringoma, and 14 patients with LN. The RCM images were evaluated at the epidermis, the dermoepidermal junction, and the dermis from both papule lesions and normal skin.
RESULTS: In the epidermis, the cerebriform shape was the main RCM characteristic of SK and the \"petal-like\" structure was the main RCM characteristic of VP. In the dermoepidermal junction, the RCM features we found were as follows: For SK, the bright dermal papillary rings, the abnormal dermal papilla and the looped vessels were also observed at the abnormal dermal papilla. For VP, the bright dermal papillary rings and the point-like blood vessels were also observed at the round dermal papills. For LN, the round, enlarged, well-circumscribed dermal papillae and the enlarged dermal papillaes were heavily laden with individual highly refractive cells. In the dermis, RCM examination revealed brightly refractile teratogenous sweat tube, designing variably visible bright \"moon\" structures in all syringoma patients.
CONCLUSIONS: Considering our results, RCM may be useful to non-invasively discriminate SK, VP, syringoma and LN in vivo.

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