Eruptive Vellus Hair Cysts Clinical Presentation
- Author: Cory A Dunnick, MD; Chief Editor: William D James, MD more...
Eruptive vellus hair cysts (EVHCs) typically develop as an acneiform eruption on the chest and extremities. 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.
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. A single case report describes unilateral EVHCs of the face.
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.
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.
Esterly NB, Fretzin DF, Pinkus H. Eruptive vellus hair cysts. Arch Dermatol. 1977 Apr. 113(4):500-3. [Medline].
Binhlam JQ, Gross AS, Onadeko OO, Dutt PL, King LE Jr. Acneiform eruption due to eruptive vellus hair cysts. South Med J. 1992 Mar. 85(3):322-5. [Medline].
Reep MD, Robson KJ. Eruptive vellus hair cysts presenting as multiple periorbital papules in a 13-year-old boy. Pediatr Dermatol. 2002 Jan-Feb. 19(1):26-7. [Medline].
Park JH, Her Y, Chun BM, Kim CW, Kim SS. A case of eruptive vellus hair cysts that developed on the labium major. Ann Dermatol. 2009 Aug. 21(3):294-6.
Benoldi D, Allegra F. Congenital eruptive vellus hair cysts. Int J Dermatol. 1989 Jun. 28(5):340-1. [Medline].
Mayron R, Grimwood RE. Familial occurrence of eruptive vellus hair cysts. Pediatr Dermatol. 1988 May. 5(2):94-6. [Medline].
Rodgers SA, Kitagawa K, Selim MA, Bellet JS. Familial eruptive vellus hair cysts. Pediatr Dermatol. 2012 May. 29(3):367-9. [Medline].
Yanik ME, Aliagaoglu C, Güvenç SC, Yildirim U, Albayrak H. Eruptive vellus hair cysts occurring on the ears. J Dermatol. 2009 Jun. 36(6):360-1. [Medline].
Lew BL, Lee MH, Haw CR. Unilateral eruptive vellus hair cysts occurring on the face. J Eur Acad Dermatol Venereol. 2006 Nov. 20(10):1314-6. [Medline].
Chan KH, Tang WY, Lam WY, Lo KK. Eruptive vellus hair cysts presenting as bluish-grey facial discoloration masquering as naevus of Ota. Br J Dermatol. 2007 Jul. 157(1):188-9. [Medline].
Li Y, Shan SJ, Luo S, Zhang S, Liu Q. Eruptive vellus hair cysts in association with syringomas. Eur J Dermatol. 2012 May-Jun. 22(3):394-5. [Medline].
Lee HT, Chang SH, Yoon TY. Eruptive vellus hair cyst in a patient with pachyonychia congenita. J Dermatol. 1999 Jun. 26(6):402-4. [Medline].
Takeshita T, Takeshita H, Irie K. Eruptive vellus hair cyst and epidermoid cyst in a patient with pachyonychia congenita. J Dermatol. 2000 Oct. 27(10):655-7. [Medline].
Romiti R, Festa Neto C. Eruptive vellus hair cysts in a patient with ectodermal dysplasia. J Am Acad Dermatol. 1997 Feb. 36(2 Pt 1):261-2. [Medline].
Köse O, Tastan HB, Deveci S, Gür AR. Anhidrotic ectodermal dysplasia with eruptive vellus hair cysts. Int J Dermatol. 2001 Jun. 40(6):401-2. [Medline].
Mieno H, Fujimoto N, Tajima S. Eruptive vellus hair cyst in patients with chronic renal failure. Dermatology. 2004. 208(1):67-9. [Medline].
Morgan MB, Kouseff BG, Silver A, et al. Eruptive vellus hair cysts and neurologic abnormalities: two related conditions?. Cutis. 1991 Jun. 47(6):413-5. [Medline].
Nandedkar MA, Minus H, Nandedkar MA. Eruptive vellus hair cysts in a patient with Lowe syndrome. Pediatr Dermatol. 2004 Jan-Feb. 21(1):54-7. [Medline].
Kaya TI, Tataroglu C, Tursen U, Ikizoglu G. Eruptive vellus hair cysts: an effective extraction technique for treatment and diagnosis. J Eur Acad Dermatol Venereol. 2006 Mar. 20(3):264-8. [Medline].
Alfaro-Castellon P, Mejia-Rodriguez SA, Valencia-Herrera A, Ramírez S, Mena-Cedillos C. Dermoscopy Distinction of Eruptive Vellus Hair Cysts with Molluscum Contagiosum and Acne Lesions. Pediatr Dermatol. 2012 May 29. [Medline].
Kiene P, Hauschild A, Christophers E. Eruptive vellus hair cysts and steatocystoma multiplex. variants of one entity?. Br J Dermatol. 1996 Feb. 134(2):365-7. [Medline].
Zaharia D, Kanitakis J. Eruptive vellus hair cysts: report of a new case with immunohistochemical study and literature review. Dermatology. 2012. 224(1):15-9. [Medline].
Tomková H, Fujimoto W, Arata J. Expression of keratins (K10 and K17) in steatocystoma multiplex, eruptive vellus hair cysts, and epidermoid and trichilemmal cysts. Am J Dermatopathol. 1997 Jun. 19(3):250-3. [Medline].
Ahn SK, Chung J, Lee WS, Lee SH, Choi EH. Hybrid cysts showing alternate combination of eruptive vellus hair cyst, steatocystoma multiplex, and epidermoid cyst, and an association among the three conditions. Am J Dermatopathol. 1996 Dec. 18(6):645-9. [Medline].
Jerasutus S, Suvanprakorn P, Sombatworapat W. Eruptive vellus hair cyst and steatocystoma multiplex. J Am Acad Dermatol. 1989 Feb. 20(2 Pt 1):292-3. [Medline].
Ohtake N, Kubota Y, Takayama O, Shimada S, Tamaki K. Relationship between steatocystoma multiplex and eruptive vellus hair cysts. J Am Acad Dermatol. 1992 May. 26(5 Pt 2):876-8. [Medline].
Saks K, Levitt JO. Tazarotene 0.1 percent cream fares better than erbium:YAG laser or incision and drainage in a patient with eruptive vellus hair cysts. Dermatol Online J. 2006. 12(6):7. [Medline].
Urbina-González F, Aguilar-Martínez A, Cristóbal-Gil MC, Sánchez de Paz F. The treatment of eruptive vellus hair cysts with isotretinoin. Br J Dermatol. 1987 Mar. 116(3):465-6. [Medline].
Erkek E, Kurtipek GS, Duman D, Sanli C, Erdogan S. Eruptive vellus hair cysts: report of a pediatric case with partial response to calcipotriene therapy. Cutis. 2009 Dec. 84(6):295-8. [Medline].
Sárdy M, Kárpáti S. Needle evacuation of eruptive vellus hair cysts. Br J Dermatol. 1999 Sep. 141(3):594-5. [Medline].
Huerter CJ, Wheeland RG. Multiple eruptive vellus hair cysts treated with carbon dioxide laser vaporization. J Dermatol Surg Oncol. 1987 Mar. 13(3):260-3. [Medline].
Kageyama N, Tope WD. Treatment of multiple eruptive hair cysts with erbium:YAG laser. Dermatol Surg. 1999 Oct. 25(10):819-22. [Medline].
Coras B, Hohenleutner U, Landthaler M, Hohenleutner S. Early recurrence of eruptive vellus hair cysts after Er:YAG laser therapy: case report and review of the literature. Dermatol Surg. 2005 Dec. 31(12):1741-4. [Medline].
Helbig D, Bodendorf MO, Grunewald S, et al. Comparative treatment of multiple vellus hair cysts with the 2940 nm Er:YAG and 1540 nm Er:Glass laser. J Cosmet Laser Ther. 2011 Oct. 13(5):223-6. [Medline].