An eight-year-old boy was referred to the dermatology department of the University Hospital of Antwerp. He complained about a wet wrist since 2 months. The wet spot was well defined and localised unilaterally on the right forearm with on top clearly visual water droplets. The patient gets this complaint on a daily basis, several times a day but not in a continuous way. There is no itch and no pain. No notable precipitating factors, like a correlation with stressful events or new products, are described. System anamnesis is negative. The patient is not atopic, has no allergies nor has any previous medical history. The patient did not take any medication nor applied local creams on the spot.
Clinical examination at time of consultation showed no abnormalities, except of very discrete slightly erythematous skin. The skin was dry. No pigmentation was seen. A the time of consultation no water droplets were seen, but multiple photo’s were brought to the consultation.
A biopsy of the affected area was taken and showed a large number of eccrine gland structures in the mid dermis and deep dermis. There was no cytonuclear abnormality seen in the ducti. Predominantly adipocytes were seen around the glands. No blood vessel structures were seen around them. The diagnosis of an eccrine naevus was made.
An eccrine naevus is a rare cause of local hyperhidrosis. Only few cases are described in literature worldwide. Both men and women are equally affected and the most common site of disease is the forearm. Most lesions appear during childhood and adolescence. Various clinical presentations are seen, appearing as papules, nodules, plaques or without any overt skin abnormalities. Three subtypes are seen, differentiating a classic eccrine naevus with an eccrine angiomatous hamartoma and a mucinous eccrine naevus. Histopathological examination shows in all three an increase in number or size of otherwise structurally normal eccrine glands but with other variable compositions such as respectively blood vessels and abundant mucin deposits. Therapeutic options include topical aluminium chloride, systemic anticholinergic agents, iontophoresis, intralesional botulinum toxin and surgical excision. A study from Lueangarun et al. with use of topical botulinum toxin as a non-invasive technique for primary (axillary) hyperhidrosis is promising but experimental. [1-4]
In our case we started the boy on topical aluminium chloride with only minimal improvement. Symptom control with a wrist sweatband was proposed. In dialogue with mother and patient, no further invasive therapeutic options were desired. The patient and mother noticed that a smaller wet spot was left after the biopsy was taken, showing less droplets proximal to the biopsy place.
References
- Tempark, T. and Shwayder, T. (2013), Mucinous eccrine naevus: case report and review of the literature. Clin Exp Dermatol, 38: 1-6. doi:10.1111/ced.12034
- Vázquez MR, Gómez de la Fuente E, Fernández JG, Martin FJ, Estebaranz JL, Moraleda FP. Eccrine naevus: case report and literature review. Acta Derm Venereol. 2002;82(2):154-6. doi: 10.1080/00015550252948310. PMID: 12125955.
- Man XY, Cai SQ, Zhang AH, Zheng M. Mucinous eccrine naevus presenting with hyperhidrosis: a case report. Acta Derm Venereol. 2006;86(6):554-5. doi: 10.2340/00015555-0144. PMID: 17106610.
- Lueangarun S, Sermsilp C, Tempark T. Topical Botulinum Toxin Type A Liposomal Cream for Primary Axillary Hyperhidrosis: A Double-Blind, Randomized, Split-Site, Vehicle-Controlled Study. Dermatol Surg. 2018 Aug;44(8):1094-1101. doi: 10.1097/DSS.0000000000001532. PMID: 29659406.
Van Loon A.1,2, Broeckx G. 3, Leysen J. 1,2 , Aerts O.1,2, De Moor A.1, Lambert J.1,2
Department of Dermatology, Antwerp University Hospital, Edegem, Belgium.
University of Antwerp, Antwerp, Belgium.
Department of Pathology, Antwerp University Hospital, Edegem, Belgium.