Letter - Clinical
Case for diagnosis. Unusual involvement of asymptomatic facial papular eruption: eruptive vellus hair cysts
Denys Elizabeth Peñaloza Daguer
, Alicia Kowalczuk, Mariana Paula Caviedes, Luis Daniel Mazzuoccolo
Corresponding author
Department of Dermatology, Italian Hospital of Buenos Aires, CABA, Argentina
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Unusual involvement of asymptomatic facial papular eruption: eruptive vellus hair cysts" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "694" "paginaFinal" => "696" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Denys Elizabeth Peñaloza Daguer, Alicia Kowalczuk, Mariana Paula Caviedes, Luis Daniel Mazzuoccolo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Denys Elizabeth" "apellidos" => "Peñaloza Daguer" "email" => array:1 [ 0 => "denys.penaloza@hospitalitaliano.org.ar" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Alicia" "apellidos" => "Kowalczuk" ] 2 => array:2 [ "nombre" => "Mariana Paula" "apellidos" => "Caviedes" ] 3 => array:2 [ "nombre" => "Luis Daniel" "apellidos" => "Mazzuoccolo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, Italian Hospital of Buenos Aires, CABA, Argentina" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1252 "Ancho" => 3258 "Tamanyo" => 742352 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A‒C) Numerous distinct (1‒3<span class="elsevierStyleHsp" style=""></span>mm) smooth skin-colored papules concentrated on the cheeks and the ears</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 44-year-old female patient presented with a medical history of asymptomatic skin lesions covering her face and ears. The lesions had started in puberty with an increasing number since then. She had been treated for acne with topical retinoids, antibiotics, and oral isotretinoin with no improvement. Physical examination showed numerous distinct (1‒3<span class="elsevierStyleHsp" style=""></span>mm) smooth skin-colored papules concentrated on the cheeks and the ears (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> A‒C). There was no family history of similar lesions. A punch biopsy of a papule on the left cheek was performed. The specimen was submitted for histopathological examination (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">What’s your diagnosis?</span><p id="par0010" class="elsevierStylePara elsevierViewall">a. Acneiform eruption</p><p id="par0015" class="elsevierStylePara elsevierViewall">b. Steatocystoma multiplex</p><p id="par0020" class="elsevierStylePara elsevierViewall">c. Epidermal cysts</p><p id="par0025" class="elsevierStylePara elsevierViewall">d. Eruptive vellus hair cysts</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">After correlating the clinical and histological findings, the diagnosis of eruptive vellus hair cysts (EVHC) with facial involvement was established.</p><p id="par0035" class="elsevierStylePara elsevierViewall">EVHC are a rare benign follicular developmental abnormality of the vellus hair follicles that Esterly and Cols first described in 1977.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> They are most commonly seen in children, adolescents, or young adults, affecting different genders and ethnicities equally. They could be sporadic or inherited (autosomal dominant). Furthermore, mutations in the gene that encodes keratin 17 have been described.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Clinically, EVHC typically are seen as asymptomatic smooth skin-colored to slightly hyperpigmented follicular papules of 1–4<span class="elsevierStyleHsp" style=""></span>mm in diameter with a centrally umbilicated surface usually involving the chest, abdomen, and limbs.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The facial involvement is uncommon. EVHC has been described as macular, papular, skin-colored, pink, slate hyperpigmented, nevus of Ota-like, and even unilateral. Sites of involvement include the forehead, cheeks, and periorbital areas.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The clinical presentation is often not enough for a definitive diagnosis, which requires a histopathological examination.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Histologically, they are well-circumscribed cystic lesions in the mid-dermis and/or superficial dermis. The lining epithelium of the cyst wall resembles the infundibular or isthmic portion of the hair follicle and contains two to three layers of stratified squamous epithelium with focal areas of the granular layer. The cyst cavity contains a variable amount of laminated keratin and numerous transversally and obliquely cut vellus hairs. The cyst wall may be in continuity with an atrophied hair follicle or arrector pili muscle. Usually, no sebaceous glands are present within the cyst wall.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The most relevant differential diagnosis for this atypical presentation of EVHC is steatocystoma multiplex, which shows a very marked clinical overlap and can be distinguished only by histopathological examination.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Other differential diagnoses are acneiform eruptions, milia, and folliculitis.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Although the spontaneous resolution of eruptive vellus hair cysts has been reported, treatment of this condition is often challenging. Therapeutic options include destructive methods such as dermabrasion, excision, and ablative lasers. Topical lactic acid, topical and oral retinoids, and urea creams have also been tried with varying degrees of success.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors’ contributions</span><p id="par0070" class="elsevierStylePara elsevierViewall">Denys Elizabeth Peñaloza Daguer: Preparation and writing of the manuscript; intellectual participation in propaedeutic and/or therapeutic management of studied case and Study conception and planning.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Alicia Kowalzuck: Intellectual participation in propaedeutic and/or therapeutic management of studied cases.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Mariana Paula Caviedes: Intellectual participation in propaedeutic and/or therapeutic management of studied cases.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Luis Daniel Mazzuoccolo: Critical literature review and approval of the final version of the manuscript.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "What’s your diagnosis?" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Financial support" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Authors’ contributions" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-06-21" "fechaAceptado" => "2022-08-07" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Italian Hospital of Buenos Aires, Caba, Argentina.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1252 "Ancho" => 3258 "Tamanyo" => 742352 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A‒C) Numerous distinct (1‒3<span class="elsevierStyleHsp" style=""></span>mm) smooth skin-colored papules concentrated on the cheeks and the ears</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1093 "Ancho" => 2917 "Tamanyo" => 389162 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Microscopic Findings. Biopsy specimen from the cheek showing a mid-dermal cyst with abundant lamellated keratin and several vellus hair shafts are present inside the cyst, (A) Hematoxylin & eosin, ×10, (B) Hematoxylin & eosin, ×40.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eruptive vellus hair cyst: an uncommon and underdiagnosed entity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Anand" 1 => "N. Sarin" 2 => "R. Misri" 3 => "V.K. 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Tosti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2015.01.024" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2015" "volumen" => "72" "paginaInicial" => "890" "paginaFinal" => "900" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25748313" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Asymptomatic papular lesions on the trunk" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Rao" 1 => "C. Balachandran" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0378-6323.48687" "Revista" => array:6 [ "tituloSerie" => "Indian J Dermatol Venereol Leprol" "fecha" => "2009" "volumen" => "75" "paginaInicial" => "217" "paginaFinal" => "219" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19293527" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eruptive vellus hair cysts: an underdiagnosed entity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.S. Patokar" 1 => "A.R. Holani" 2 => "G.H. Khandait" 3 => "S.S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 17 | 2 | 19 |
| 2024 October | 137 | 63 | 200 |
| 2024 September | 164 | 80 | 244 |
| 2024 August | 158 | 112 | 270 |
| 2024 July | 119 | 98 | 217 |
| 2024 June | 127 | 95 | 222 |
| 2024 May | 94 | 63 | 157 |
| 2024 April | 102 | 86 | 188 |
| 2024 March | 98 | 74 | 172 |
| 2024 February | 100 | 78 | 178 |
| 2024 January | 105 | 57 | 162 |
| 2023 December | 104 | 78 | 182 |
| 2023 November | 145 | 102 | 247 |
| 2023 October | 175 | 92 | 267 |
| 2023 September | 211 | 106 | 317 |
| 2023 August | 314 | 117 | 431 |
| 2023 July | 131 | 38 | 169 |
| 2023 June | 60 | 42 | 102 |
| 2023 May | 38 | 36 | 74 |
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