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Cysts are usually dome-shaped with a smooth surface, measuring 1-4 mm in diameter. Cysts sometimes demonstrate central puncta, hyperkeratotic crusts, or umbilication. Mechanical irritation of the cysts may produce transepidermal elimination of retained vellus hairs, similar to that seen in perforating folliculitis. Eruptive vellus hair cysts are likely to be familial when they occur in early childhood.
Eruptive Vellus Hair Cysts: An Underdiagnosed Entity
Simple excision (eg, punch biopsy technique) removes the cyst; however, this is not practical for most cases of EVHCs because the cysts are too numerous and punch biopsy scars may be unsightly. Most lesions persist if untreated, but approximately 25% of cases may undergo spontaneous resolution due to transepidermal elimination of cyst contents and inflammatory destruction. Differential diagnosis of milia, steatocystoma multiplex (SM), EVHCs were considered. Other clinical differentials include comedones, keratosis pilaris, syringoma, milium, and molluscum contagiosum.[16,17] EVHCs are often clinically misdiagnosed due to its resemblance to various mimicking lesions as it occurred in our case. Hence, histopathological examination is mandatory to differentiate these lesions from EVHC.
Eruptive Vellus Hair Cysts Clinical Presentation
They may be topped with central puncta, umbilicated or a hyperkeratotic crust. The usual age of onset is between 17 and 24 years, but they can occur at any age. Vellus hair, or peach fuzz, protects your skin and helps your body regulate its temperature. These fine, thin hairs do important work all over your body. If you’re not happy with how vellus hair looks, there are ways to remove it. Talk to your healthcare provider about the right option for you and whether you want to remove peach fuzz temporarily or permanently.
CASE REPORT
An epidermoid cyst is also called a follicular infundibular cyst, epidermal cyst, and keratin cyst. Disclaimer - the author PCDS cannot accept responsibility for any misleading or incorrect statements, and the management of individual patients remains the direct responsibility of the individual doctor. All named individuals and organisations maintain copyright for the relevant images.
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The cyst may be surrounded by a granulomatous inflammation,[11] leading to partial destruction of the cyst wall. Eruptive vellus hair cysts (or EVHC) are small lesions that occur most often in the chest wall, abdomen and extremities, often with a crusted surface. EVHC may occur randomly, or it can be inherited as an autosomal dominant trait; sporadic cases usually appear at 4–18 years of age.
Eruptive Vellus Hair Cysts Differential Diagnoses
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Infundibular cysts do not contain sebaceous glands or vellus hairs. The cyst of SCM arises in the sebaceous duct and has an eosinophilic hyaline lining to the cyst wall where there is an absence of granular layer. Immunohistochemical staining with K10 and K17 revealed that EVHC and SCM were two distinct lesions.[7] SCM expresses both K10 and K17 while EVHC expresses only K17. The differential diagnosis of pilosebaceous cysts includes infundibular cysts, steatocystoma multiplex, and EVHCs. All 3 commonly affect the anterior chest and consist of asymptomatic papules or nodules. Obstructed or occluded follicles form the common infundibular cysts.
The patient was advised topical treatment of retinoic acid cream (0.05%) for 6 months, and he is currently under follow-up period. Due to its rarity and resemblance to many similar entities, histopathological examination plays a major role in establishing a definite diagnosis and further proper management of the patient. We report this unusual case to generate awareness about this rarely diagnosed condition.
In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. EVHCs are either sporadic or inherited in autosomal dominant fashion. In sporadic occurrence, they appear in the first and second decades of life. It can affect both genders equally, and there is no ethical or racial difference. It’s usually shorter and lighter in color than terminal hair.
The cysts appear similar clinically to steatocystoma multiplex, as well as acneiform eruptions and milia. Retinoids, surgery, and lasers are used as treatment modalities. The differential diagnosis of pilosebaceous cysts includes infundibular cysts, SCM, and EVHCs. All three occur as asymptomatic papules or nodules affecting the anterior chest wall most commonly.
Tomková H, Fujimoto W, Arata J. Expression of keratins (K10 and K17) in steatocystoma multiplex, eruptive vellus hair cysts, and epidermoid and trichilemmal cysts. More than 50 cases have been reported in the literature; however, eruptive vellus hair cysts (EVHCs) may occur more frequently than is suggested by reports, possibly because the diagnosis is only definitively confirmed with biopsy. Eruptive vellus hair cysts are small papules containing vellus hairs. Alternatively, the diagnosis can be confirmed with a potassium hydroxide wet mount of cyst contents extruded through a small incision. Microscopic examination of the cyst contents reveals vellus hairs.
The usual onset is between 17 and 24 years but may be congenital. It can arise sporadically or may be inherited in an autosomal dominant fashion. They are caused by an abnormality at the infundibular level of vellus hairs. They usually appear as yellow to reddish-brown papules over the chest, limbs, and abdomen. Histologically, cyst has a stratified squamous epithelium and it contains lamellated keratin and several vellus hairs.
There may be few to numerous cysts, sometimes numbering in the hundreds. A 24-year-old man was concerned about the small “bumps” on his abdomen that had been increasing in number over the past several years. The patient denied a family history of similar lesions. Examination revealed about 15 to 20 scattered, nontender, skin-colored/bluish, firm 2 to 3-mm papules on the abdomen (A and B).
A gradual disruption occurs between the proximal and distal parts of the follicle, usually at the level of the infundibulum. This results in the retention of hairs, cystic dilatation of the proximal follicle, and subsequent atrophy of the hair bulb. EVHC was first described by Esterly, Fretzin, and Pinkus in 1977. While some authors believe it to be a hamartoma differentiating toward vellus hairs.
Vellus hairs also protect your skin and help you sense the world around you. The tiny hairs help you feel light objects against your skin. When you get goosebumps, your vellus hair allows you to feel them. EVHC may occur randomly, or it can be inherited as an autosomal dominant trait. The condition affects males and females equally, and sporadic cases usually appear at 4–18 years of age.
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