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Eruptive Vellus Hair Cysts Clinical Presentation

  • Author: Cory A Dunnick, MD; Chief Editor: William D James, MD  more...
 
Updated: May 21, 2014
 

History

Eruptive vellus hair cysts (EVHCs) typically develop as an acneiform eruption on the chest and extremities.[2] EVHCs have also been reported on the eyelids and periorbital skin,as well as the labium major.[3, 4] Often, no antecedent trauma or triggering factor is reported. EVHCs may be congenital or acquired. Several reports have noted familial cases in which the condition is thought to be inherited as an autosomal dominant trait.[5, 6, 7] EVHCs may be present at birth or arise in childhood. In sporadic cases, lesions typically arise in the first and second decades with the onset of puberty.

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Physical

Eruptive vellus hair cysts (EVHCs) appear clinically as discrete follicular papules. Papules may appear erythematous, yellow, bluish-gray, or even slightly brown. The chest and flexor or extensor surfaces of the extremities are the most common sites of involvement. Generalized EVHCs and facial variants are reported. EVHCs may also be seen on the ears.[8] A single case report describes unilateral EVHCs of the face.[9]

Patients may have just a few cysts, or, often, they may have several hundred. More than 400 cysts were seen on a patient with generalized EVHC. 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.

Note the images below.

Clinical photo of eruptive vellus hair cysts showiClinical photo of eruptive vellus hair cysts showing involvement on the patient's chest.
Eruptive vellus hair cysts in the axilla. Eruptive vellus hair cysts in the axilla.
The patient seen here is expanding his cheek with The patient seen here is expanding his cheek with air to better demonstrate multiple eruptive vellus hair cysts on the face.
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Causes

Eruptive vellus hair cysts (EVHCs) occur as a developmental abnormality of vellus hair follicles. 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.

EVHCs have also been considered a type of follicular hamartoma. The cyst wall may consist of keratinization patterns from different levels of the follicular infundibulum. The keratinization is generally that of the epidermis or the outer root sheath, but foci of trichilemmal keratinization have also been reported.

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Contributor Information and Disclosures
Author

Cory A Dunnick, MD Associate Professor, Director of Contact Dermatitis Clinic, Director of Medical Student Education, Department of Dermatology, University of Colorado Denver School of Medicine

Cory A Dunnick, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, Women's Dermatologic Society, American Contact Dermatitis Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Harry Dao, Jr, MD Assistant Professor, Department of Dermatology, Baylor College of Medicine

Harry Dao, Jr, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References
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Clinical photo of eruptive vellus hair cysts showing involvement on the patient's chest.
Histopathology of an eruptive vellus hair cyst showing a middermal cyst with squamous epithelium.
A close-up view of the contents of an eruptive vellus hair cyst showing cross-sections of vellus hairs and laminated keratinous material.
Eruptive vellus hair cysts in the axilla.
The patient seen here is expanding his cheek with air to better demonstrate multiple eruptive vellus hair cysts on the face.
 
 
 
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