Hidrocystoma (eccrine and apocrine)

Definition

Hidrocystomas are benign cystic lesions of the sweat glands. A distinction is made between apocrine and eccrine hidrocystomas; their origin (retention cyst or adenomatous lesion, apocrine or eccrine) is viewed differently in the literature.

Classification

• Apocrine hidrocystoma (apocrine cystadenoma): usually a solitary translucent cyst, typically on the eyelid.
• Eccrine hidrocystoma: often multiple, for example on the lower eyelid or the face.

Occurrence & epidemiology

Mainly adults are affected; in two case series (107 and 20 patients) the mean age was 56 years. In a series of 22 hidrocystomas, 73% were located on the eyelids. Multiple apocrine hidrocystomas of the eyelids occur in Schöpf-Schulz-Passarge syndrome, a rare autosomal recessive genodermatosis with palmoplantar keratoderma, hypodontia, hypotrichosis and nail dystrophy.

Clinical features

• Usually a solitary translucent, skin-coloured to bluish nodule or papule with jelly-like contents, mainly on the head and neck.
• The bluish colour results from light scattering (Tyndall effect).
• Eccrine hidrocystomas often present as several small papules, some skin-coloured, some dark.

Histology

Unilocular or multilocular cyst in the dermis. Apocrine: bilaminar epithelium with inner columnar eosinophilic cells and decapitation secretion ("apocrine snouts"). Eccrine: thin epithelium of one to two layers without decapitation secretion.

Diagnosis

• Clinical (translucent bluish cyst, typical site).
• Dermoscopy in eccrine hidrocystoma: homogeneous bluish-purplish centre with a pale halo.
• Histology confirms the diagnosis and distinguishes it from basal cell carcinoma, among others.

Differential diagnoses

• Syringoma
• Trichoepithelioma
• Milia (milium)
• Epidermoid cyst
• Basal cell carcinoma

Keep learning in the app

References (selection)

1. DermNet: Sweat gland lesions (Hidrocystoma)
2. DermNet: Apocrine hidrocystoma pathology
3. DermNet: Eccrine hidrocystoma pathology
4. PubMed: Cutaneous lesions of the nose (PMID 20525327; Volltext über Europe PMC gelesen)
5. PubMed: Apocrine and eccrine hidrocystomas: a clinicopathological study (PMID 34169699)
6. PubMed: Bi-institutional retrospective study on the demographics and basic clinical presentation of hidrocystomas (PMID 28722532)
7. PubMed: Hidrocystomas--a brief review (PMID 17406184)
8. PubMed: Pale halo surrounding a homogeneous bluish-purplish central area: dermoscopic clue for eccrine hidrocystoma (PMID 26693090)

Cross-references