Multiple eccrine hidrocystomas of the face treated successfully with 1% atropine eye drops.

Sir,

Hidrocystomas are cystic tumours of the skin. They are classified into two types, namely, apocrine and eccrine hidrocystomas (ECs). ECs are small and tense thin-walled cysts, ranging from 1 to 6 mm in diameter, and can occur as single or multiple lesions.[1] ECs are prevalent in adults between 30 and 70 years of age. Multiple ECs are mainly seen in female patients.[1] Here we present a case of a 61-year-old woman with multiple ECs on the face.

A 61 years old woman presented with asymptomatic lesions on the face since 15 years, which appeared only in summer and disappeared completely after 3–4 months with the onset of monsoons. She was concerned about its unsightly cosmetic appearance and had had multiple consultations over the years with no respite. On examination, multiple skin-coloured papules, 1–3 mm in diameter some appearing cystic were seen on the face, more in the central area [Figure 1].

Figure 1

Pretreatment photograph showing multiple skin-coloured papules

A differential diagnosis of EC, syringoma and milia was considered and a 4 mm skin punch biopsy was done. Biopsy results showed unilocular cystic spaces in the dermis, lined by a double layer of epithelial cells, which was consistent with the diagnosis of EC [Figure 2a, 2b]. We refrained from using physical destructive modalities to prevent any unwanted cosmetic outcomes. We adopted a more conservative approach and started the patient on 1% atropine eye drops for local application twice daily for 1 month. The patient reported significant improvement and was very satisfied with the treatment [Figure 3a, 3b]. No side effects such as blurring of vision or dryness of the mouth were reported.

Figure 2

(a, b) - H&E stain showing unilocular cystic spaces

Figure 3

(a, b) - After treatment with 1% atropine eye drops for 1 month

EC are rare, benign, cystic lesions and are of two types; the classic Robinson type (multiple type) seen in women working in a hot and humid environment and the Smith and Chernosky type (solitary type).[2] Our case was of the Robinson type which aggravated in the hot and humid summers of Mangalore. The exact pathogenesis is unknown. One of the pathogenesis proposed is the closure of the pores causing secondary dilatation of the sweat duct or adenomatous proliferation of the excretory duct.[3]

ECs have to be differentiated with apocrine hidrocystomas and this is often difficult both clinically and histologically. Apocrine hidrocystomas are generally solitary and do not show seasonal changes or become symptomatic in hot weather. ECs are generally unilocular whereas apocrine hidrocystomas are usually multilocular.[1]

Various treatment modalities have been tried, with variable results.[4] In a report of two cases by Khunger et al.,[5]1% atropine cream was used twice a day for 2 weeks without much benefit. However, our patient showed tremendous improvement with atropine eye drops applied locally twice daily for a month.

This case has been reported in view of the excellent response of multiple EC of the face to local atropine eye drop application.

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Conflicts of interest

There are no conflicts of interest.