Eruptive Vellus Hair Cysts Clinical Presentation

  • Author: Cory A Dunnick, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 9, 2010
 

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.[3] 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.[4, 5] 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.[6] A single case report describes unilateral EVHCs of the face.[7]

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  Assistant Professor, Director of Contact Dermatitis Clinic, Director of Medical Student Education, Department of Dermatology, University of Colorado Denver Health Sciences Center

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Marjan Garmyn, MD, PhD  Professor, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium; Chair and Adjunct Head, Department of Dermatology, University of Leuven, Belgium

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

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, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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  2. Binhlam JQ, Gross AS, Onadeko OO, Dutt PL, King LE Jr. Acneiform eruption due to eruptive vellus hair cysts. South Med J. Mar 1992;85(3):322-5. [Medline].

  3. Reep MD, Robson KJ. Eruptive vellus hair cysts presenting as multiple periorbital papules in a 13-year-old boy. Pediatr Dermatol. Jan-Feb 2002;19(1):26-7. [Medline].

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  12. 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. Dec 1996;18(6):645-9. [Medline].

  13. Jerasutus S, Suvanprakorn P, Sombatworapat W. Eruptive vellus hair cyst and steatocystoma multiplex. J Am Acad Dermatol. Feb 1989;20(2 Pt 1):292-3. [Medline].

  14. Ohtake N, Kubota Y, Takayama O, Shimada S, Tamaki K. Relationship between steatocystoma multiplex and eruptive vellus hair cysts. J Am Acad Dermatol. May 1992;26(5 Pt 2):876-8. [Medline].

  15. 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].

  16. 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. Mar 1987;116(3):465-6. [Medline].

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  24. Romiti R, Festa Neto C. Eruptive vellus hair cysts in a patient with ectodermal dysplasia. J Am Acad Dermatol. Feb 1997;36(2 Pt 1):261-2. [Medline].

  25. Köse O, Tastan HB, Deveci S, Gür AR. Anhidrotic ectodermal dysplasia with eruptive vellus hair cysts. Int J Dermatol. Jun 2001;40(6):401-2. [Medline].

  26. Mieno H, Fujimoto N, Tajima S. Eruptive vellus hair cyst in patients with chronic renal failure. Dermatology. 2004;208(1):67-9. [Medline].

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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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