Multiple eccrine hidrocystomas associated with Graves’ disease

Abstract

A 20‐year‐old Korean woman presented in August 1999 with a 3‐month history of multiple, tiny papules on the periorbital and malar areas (Fig. 1a). She had noted hyperhidrosis for the preceding 6 months, even at room temperature. She had been well and had received no medication prior to her first visit to our clinic. Physical examination showed yellow colored, translucent, small papules, as well as finger tremor, exophthalmos, and a goiter. Histologic examination demonstrated cystic structures in the dermis lined with two layers of cuboidal epithelial cells (Fig. 2). The epidermis was normal and the rete ridges were partially effaced. Immunohistochemical studies revealed that the epithelial cells of the cyst wall were carcinoembryonic antigen (CEA) positive but S‐100 protein negative. 1 Multiple tiny papules on the periorbital and malar areas before (a) and after (b) treatment for Graves’ disease 2 Staining with hematoxylin and eosin (× 100); (b) Staining with hematoxylin and eosin (× 200); (c) CEA‐positive epithelial cells; (d) S‐100 protein‐negative epithelial cells Because a goiter and finger tremor were noted on physical examination, hyperthyroidism was suspected. Thyroid function test results were: triiodothyronine (T3), 8.0 ng/mL (normal range, 0.7–1.9 ng/mL); free thyroxine (T4), 8.1 ng/mL (0.7–1.9 ng/mL); T4, 35 µg/dL (6.0–11.8 µg/dL); thyroid‐stimulating hormone (TSH), 0.04 IU/mL (0.25–4.0 IU/mL); positive for anti‐TSH receptor antibody. On the basis of these findings, the patient was diagnosed with Graves’ disease and treated with methimazole, 40 mg/day. As the patient's symptoms improved, the therapeutic dose was decreased to 20 mg/day. Four months after the beginning of treatment, the free T4 and T3 values had returned to the normal range (Table 1). The skin lesions, finger tremor, and hyperhidrosis had also disappeared. Exophthalmos was improved, but still present (Fig. 1b). Comparison of thyroid hormone values in Graves’ disease pretreatment and post‐treatment T3 (ng/mL) Free T4 (ng/mL) Pretreatment8.08.1Post‐treatment1.00.15 T3, triiodothyronine; T4, thyroxine.

Multiple eccrine hidrocystomas treated with botulinum toxin A

“…Investigators have associated MEH with Graves disease in one patient, with the lesions automatically resolving when thyroid function was restored. 5 Our patient reported aggravation of the lesions after she regained thyroid hormone balance.…”

“…[2][3][4][5] Our patientÕs skin hyperpigmentation was noted a year before referral, and others have noted a similar prodrome. 2,4,5 Complete reversal of skin hyperpigmentation with vitamin B12 replacement is the norm.…”

Dermal cysts: a dermatopathological perspective and histological reappraisal

“…Eccrine hidrocystomas are most often solitary lesions involving the face, trunk and popliteal fossae but occur most prominently in the periorbital area. Typically, they affect women in hot, humid environments 45 and are thought to be related to hyperhidrosis 46 . A variant form with multiple cysts, sometimes numbering into the hundreds, can also be found 47 .…”

Multiple eccrine hidrocystomas

“…3 The individual lesions of the multiple type are similar to the solitary lesions of the Smith type, except they are smaller. 4 Treatment of multiple hidrocystomas is difficult because of their number and cosmetic location. Therapeutic options can be divided into medical and surgical modalities.…”