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Received: 15 May 2020    Revised: 24 September 2020    Accepted: 11 December 2020

DOI: 10.1111/jocd.13919

C O S M E T I C C O M M E N TA R Y

Botulinum toxin A as monotherapy for syringoma

José Luis Zaldivar-Fujigaki MSc1  | Lucia Achell Nava MD1,2

1
Departmente of Dermatology, National
Medical Center 20 de Noviembre ISSSTE, Abstract
Mexico City, Mexico Syringoma is a benign adnexal tumor of the skin originating from the eccrine sweat
2
Facultad de Medicina UNAM, National
duct. There is a wide variety of treatments, and most of the patients receive multiple
Autonomous University of Mexico, Mexico
City, Mexico unsuccessful therapies. The goal of this report intends to describe a novel technique
applicable to syringoma with botulinum toxin A. A 61-year-old female patient with
Correspondence
Lucia Achell Nava, Department of localized syringomas in the periocular and upper lip region, with a long-lasting his-
Dermatology, National Medical Center 20
tory, treated with botulinum toxin A 46 IU as monotherapy intradermally distributed
de Noviembre ISSSTE, Félix Cuevas 540, Col
del Valle Sur, Benito Juárez, 03229 Mexico and a follow-up for 8 months. Our patient displayed a significant improvement of the
City, Mexico.
syringomas. Botulinum toxin A is an efficient and safe technique to treat syringomas.
Email: luciachell50@hotmail.com

KEYWORDS

botulinum toxin, monotherapy, syringoma

1 |  I NTRO D U C TI O N
Syringoma is a benign adnexal tumor of the skin originating from the
eccrine sweat duct, commonly seen in women (2:1), often found as
multiple, tiny, firm, skin-colored papules,1,2 usually located on the
eyelid and the upper cheek, although there are reports involving
1,2
the vulvar area. We present a patient with syringomas treated
with botulinum toxin A as monotherapy in the periocular and lip
area.
2 |  C A S E R E P O RT
5 mm insulin syringe (BD Ultra-Fine™) into the lesioned area and
2-3 International Units (IU) were administered with a distance be-
tween injection sites of 1 cm2 in the periocular and upper lip area.
In each periocular area, 15 IU were delivered, distributed in 3 dif-
ferent injection sites: center, internal, and external periocular area,
and 16 IU were introduced in the upper lip area in 5 injection sites
without local anesthesia. No further treatments were required and
follow-up was made for 8 months with considerable improvement
(Figures 1-3), the patient remained with the base treatment for the
orofacial granulomatosis therapy with prednisone 2.5 mg qd and
colchicine 1 mg qd.

A 61-year-old female patient with a 4 years history of orofacial 3 | D I S CU S S I O N

granulomatosis treated with thalidomide 100 mg qd, prednisone
25 mg which decreased to 2.5 mg qd, and colchicine 1 mg qd;
depressive disorder managed with fluoxetine 20 mg qd, was pre-
sented with a long-lasting history of 1-2 mm skin-color papules
located in the periocular region, cheek, and upper lip; a biopsy
was made and it reported syringomas, which were treated with a
magistral formulation compound of resorcinol 1% and clioquinol
3% without improvement. Written consent was obtained. A 500-
unit vial of botulinum toxin A (BTX-A, Dysport®, Ipsen) was di-
luted in 2 mL of a normal saline solution without preservatives and
46 IU were intradermally distributed with a 31 G × 8 mm (5/16″),
Syringoma is a benign tumor that usually has a cosmetic concern.
There is a wide variety of treatments, and most of the patients
received multiple unsuccessful therapies, although, in the end, all
of them reported clinical improvement after a 6 months follow-
up, being laser the most frequently used. Kim et al1 reported
a clinical improvement with a 1444 nm Neodymium-Doped
Yttrium Aluminum laser; Wheeland et al3 used CO2 , Erbium YAG
laser, 4 and fractional photothermolysis, 5 which also had been
mentioned as a successful monotherapy. Other reports include
a combination of treatments with trichloroacetic acid and CO2

J Cosmet Dermatol. 2021;20:1393–1395. wileyonlinelibrary.com/journal/jocd© 2020 Wiley Periodicals LLC     1393 |

 |
1394       ZALDIVAR-FUJIGAKI and ACHELL NAVA
(A)
(A) (B)
laser, 6 temporary tattooing with Q-switched alexandrite laser and
CO2 laser in vaporization mode,7 a combination of carbon diox-
ide laser with Botulinum Toxin A, 8 and needle radiofrequency.9
Other treatments reported are ablation with intralesional insu-
10
lated needles.
The exact mechanism of how BTX-A works on syringomas is
unknown 8; it could be explained by the blockade of the cholinergic
terminals by the inhibition of the SNAP-25 (synaptosome-associ-
ated protein of 25 kd) of the SNARE complex, therefore inhibiting
F I G U R E 1   Left profile. A, Before
treatment. B, Eight months after
treatment
(B)
F I G U R E 2   Right profile. A, Before
treatment. B, Eight months after
treatment
the release of acetylcholine from cytoplasmic vesicles of the nerve
ending. The result could be chemodennervation of cholinergic
nerves, thus targeting the autonomic control of eccrine sweat
glands.11 Given that the syringoma is a tumor derived from these
glands, this could explain the clinical result obtained.
We conclude that intradermal botulinum toxin A is a painless,
cost-effective, and safe technique for the treatment of multiple
syringomas therapy in the periocular and lip area with excellent
results.
ZALDIVAR-FUJIGAKI and ACHELL NAVA
F I G U R E 3   Front profile. A, Before
treatment. B, Eight months after
treatment
DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available from
the corresponding author upon reasonable request.
ORCID
José Luis Zaldivar-Fujigaki  https://orcid.org/0000-0001-7210-5475
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How to cite this article: Zaldivar-Fujigaki JL, Achell Nava L.
Botulinum toxin A as monotherapy for syringoma. J Cosmet
Dermatol. 2021;20:1393–1395. https://doi.org/10.1111/
jocd.13919