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September 2004

Papular Eruption on a Patient With Down Syndrome—Diagnosis

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Copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2004

Arch Dermatol. 2004;140(9):1161-1166. doi:10.1001/archderm.140.9.1161-b

The skin biopsy specimen showed dermal fibrosis. In the upper dermis, there was a proliferation of eccrine-type ducts, many of which were dilated and contained eosinophilic material. The ducts were lined by 2 or more layers of cuboidal cells, often with luminal clear cell change. There was also a mild perivascular lymphohistiocytic inflammatory cell response. The epidermis displayed mild overlying hyperkeratosis.

Syringomas are benign tumors that originate in the intraepidermal eccrine ducts.1 Clinically, they are asymptomatic, small, yellow or red-brown, firm papules. They are seen more frequently in females and commonly occur in the periorbital area, especially in patients with Down syndrome. Other sites that are affected less commonly include the neck, chest, and abdomen. The incidence of syringomas in patients with Down syndrome has been reported to be approximately 30 times greater than that in the general population.2

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