Elimination of Syringomas with laser

Although syringomas originate in the glands that produce sweat (eccrine), their most common location is the periorbital region.

Treating syringomas is a treatment process that requires expertise in handling different types of laser equipment.

At Unilaser Medical, I am the only surgeon authorized to perform this procedure.

Adrián Ríos, MD
Medical Director Unilaser

It is suggested that there are specific factors in the presentation areas that favor its development:

Influence on Different Forms of Presentation:

Eyelid Syringomas : The skin around the eyes is thinner and has relatively looser connective tissue compared to other areas of the body. This could explain why eyelid syringomas are the most common form of this condition.

Eruptive Syringomas : They are characterized by the sudden appearance of multiple lesions, mainly in areas such as the neck, trunk and upper extremities. They usually appear between puberty and adolescence, which suggests some hormonal receptor.
Disseminated or Generalized Syringomas : In this form, the lesions appear in a wide area of the body. There is no known cause.
Genital Syringomas : Although they are less common, their appearance in these areas is not uncommon. Its cause is not known.

Theories of the origin of syringomas:

Intrinsic Growth Regulation:
- Although syringomas can coalesce, they only grow up to a few millimeters.
- Most grow very slowly.
- Syringomas may have intrinsic growth control mechanisms, possibly regulated at the genetic or cellular level. This would limit their size and expansion regardless of the tissue environment in which they are found.
- Regulation could be influenced by specific growth and differentiation signals of eccrine sweat gland cells, which would explain their limited development and typical distribution.
Molecular and Cellular Factors:
- The formation of syringomas could be more influenced by molecular and cellular factors specific to the cells where the outermost cells of the sweat duct originate. These factors could include signaling pathways, gene expression, and interaction with the local cellular microenvironment.
Hormonal and Systemic Influence:
- They can be influenced by hormones and systemic changes, which could affect their appearance and perhaps their size to some extent. However, this effect also appears to be finely regulated.
Spontaneous involution: Does not occur.
Absence in Palms and Plants:
- The absence of syringomas in palms and soles, despite the high concentration of eccrine glands, suggests that the location of these tumors does not depend on a higher density of eccrine glands.

To date, no specific and consistent molecular markers for syringomas have been identified.
However, research in this field is dynamic and continually developing.

Several aspects to consider are:

Histological and Molecular Studies:
- Histologically, syringomas are characterized by ductal structures in the dermis, with a specific pattern that helps in their diagnosis. At the molecular level, studies have been conducted to better understand their characteristics, but to date no unique molecular markers have been identified that are consistently associated with syringomas.
Genetic Research:
- Genetic research has been performed to better understand the etiology of syringomas, particularly in cases where there is a familial predisposition or association with genetic syndromes. However, a definitive conclusion on specific genetic markers has not yet been reached.
Immunohistochemical analysis:
- Immunohistochemical studies have been useful in differentiating syringomas from other skin lesions, but so far have not identified specific immunological markers that are unique to syringomas.
Need for More Research:
- The discovery of molecular markers for syringomas would not only improve the understanding of their pathogenesis, but could also aid in diagnosis and the development of specific therapies. Therefore, more research is needed in this area.

The fact that the removal of the majority of lesions prevents the appearance of new lesions in the years after their removal suggests several important points:

Non-Recurrent Nature of Syringomas:
- Adequate photographic documentation will show that syringomas may not be recurrent but rather would be considered persistent.
- Once good photographic documentation is available, it will be verified that with excisions, including microsurgical ones, it is not possible to see lesions that have not yet grown. The only possibility left is monitoring in order to detect these subtle growths. Once a good amount of time passes, the smallest ones can be detected.

Laser treatment at 7 months
Possible Limited Eruptive Character:
- The idea that the presentation is always in some form eruptive implies that there is an initial impulse for the development of syringomas that is not repeated over time. This could be related to specific triggering factors (hormonal, genetic, environmental) that act at a certain time and not on a continuous or recurring basis.
Implications for Understanding Etiology:
- Long-term observation of almost complete cases may offer clues to the etiology of syringomas. If its development is driven by specific factors at a given time, understanding those factors could be key to controlling its growth or developing more effective treatments.
Importance of Complete Elimination:
- The experience highlights the importance of eliminating all lesions, even the smallest ones, to avoid the false sensation of recurrence. This could be a critical aspect in the treatment of syringomas and could influence the choice of treatment techniques.
- Identifying lesions less than a millimeter in diameter as true syringomas is not possible. Only monitoring will make a conclusion possible in this regard.
Need for More Research and Clinical Data Recording:
- All clinical observations are valuable and should be documented and possibly investigated further in clinical studies.
- Collecting long-term data on treated patients could provide crucial information to better understand syringomas.

In summary, what are syringomas?

They are tumors that originate in the sweat duct of the skin.

Do syringomas continue to appear after laser treatment?

If the majority is eliminated, it is possible to achieve control to a satisfactory degree. However, as long as treatments are not carried out with this intention and isolated sessions are considered, it will not be possible to control them.

Why is laser preferable to remove syringomas?

Because they are small and numerous with a tendency to converge.

Opting for a method that causes greater inflammation will make it impossible to eliminate a good number of them.

Without using a laser, it is impossible to eliminate syringomas smaller than one millimeter in diameter.

Simplifying the treatment of removing lesions with laser is only one part.

Treating early scar complications, such as redness, fibrosis foci, hypochromia, is the other essential part of the treatment.