eMedicine Specialties > Dermatology > Benign Neoplasms

Eruptive Vellus Hair Cysts

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
Contributor Information and Disclosures

Updated: Nov 20, 2008

Introduction

Background

Eruptive vellus hair cysts (EVHCs) were first described in 1977 by Esterly and colleagues who reported 2 children with symmetrically distributed follicular papules on the chest and flexor extremities.1 Histologically, these papules had the unique characteristic of dermal cysts containing small vellus hairs.

Cases of EVHC may either be acquired or inherited in an autosomal dominant fashion. Generally, they are isolated findings. However, they have been associated with other skin disorders (eg, anhidrotic ectodermal dysplasia, hidrotic ectodermal dysplasia, pachyonychia congenita).

Pathophysiology

Eruptive vellus hair cysts (EVHCs) are thought to arise as a developmental abnormality of vellus hair follicles. A predisposition exists for follicular occlusion at the level of the infundibulum, which results in cystic dilatation of the proximal hair follicle and secondary atrophy of the hair bulb.

Frequency

International

The frequency is unknown. 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.

Mortality/Morbidity

Eruptive vellus hair cysts (EVHCs) are asymptomatic; however, they may be cosmetically bothersome. Morbidity may be associated with treatment of the disorder.

Race

Eruptive vellus hair cysts (EVHCs) have no racial predilection.

Sex

Males and females are affected equally.

Age

In familial cases, eruptive vellus hair cysts (EVHCs) are first noted at birth or during infancy. In sporadic cases, cysts usually develop in the late-first or second decade of life.

Clinical

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.

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.
    • A single case report describes unilateral EVHCs of the face.6
  • 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.

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.

More on Eruptive Vellus Hair Cysts

Overview: Eruptive Vellus Hair Cysts
Differential Diagnoses & Workup: Eruptive Vellus Hair Cysts
Treatment & Medication: Eruptive Vellus Hair Cysts
Follow-up: Eruptive Vellus Hair Cysts
Multimedia: Eruptive Vellus Hair Cysts
References
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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].

  4. Benoldi D, Allegra F. Congenital eruptive vellus hair cysts. Int J Dermatol. Jun 1989;28(5):340-1. [Medline].

  5. Mayron R, Grimwood RE. Familial occurrence of eruptive vellus hair cysts. Pediatr Dermatol. May 1988;5(2):94-6. [Medline].

  6. Lew BL, Lee MH, Haw CR. Unilateral eruptive vellus hair cysts occurring on the face. J Eur Acad Dermatol Venereol. Nov 2006;20(10):1314-6. [Medline].

  7. 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. Jul 2007;157(1):188-9. [Medline].

  8. 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. Mar 2006;20(3):264-8. [Medline].

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  10. 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. Jun 1997;19(3):250-3. [Medline].

  11. 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].

  12. 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].

  13. 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].

  14. 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].

  15. 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].

  16. Sárdy M, Kárpáti S. Needle evacuation of eruptive vellus hair cysts. Br J Dermatol. Sep 1999;141(3):594-5. [Medline].

  17. Huerter CJ, Wheeland RG. Multiple eruptive vellus hair cysts treated with carbon dioxide laser vaporization. J Dermatol Surg Oncol. Mar 1987;13(3):260-3. [Medline].

  18. Kageyama N, Tope WD. Treatment of multiple eruptive hair cysts with erbium:YAG laser. Dermatol Surg. Oct 1999;25(10):819-22. [Medline].

  19. 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. Dec 2005;31(12):1741-4. [Medline].

  20. Lee HT, Chang SH, Yoon TY. Eruptive vellus hair cyst in a patient with pachyonychia congenita. J Dermatol. Jun 1999;26(6):402-4. [Medline].

  21. Takeshita T, Takeshita H, Irie K. Eruptive vellus hair cyst and epidermoid cyst in a patient with pachyonychia congenita. J Dermatol. Oct 2000;27(10):655-7. [Medline].

  22. 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].

  23. 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].

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

  25. Morgan MB, Kouseff BG, Silver A, Shenefelt PC, Fenske NA, Espinoza CG, et al. Eruptive vellus hair cysts and neurologic abnormalities: two related conditions?. Cutis. Jun 1991;47(6):413-5. [Medline].

  26. Nandedkar MA, Minus H, Nandedkar MA. Eruptive vellus hair cysts in a patient with Lowe syndrome. Pediatr Dermatol. Jan-Feb 2004;21(1):54-7. [Medline].

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  32. Kumakiri M, Takashima I, Iju M, Nogawa M, Miura Y. Eruptive vellus hair cysts--a facial variant. J Am Acad Dermatol. Oct 1982;7(4):461-7. [Medline].

  33. Kwon KS, Lee HT, Jang HS, Chung TA, Oh CK. A case of generalized eruptive vellus hair cysts. J Dermatol. Aug 1997;24(8):556-7. [Medline].

  34. Nogita T, Chi HI, Nakagawa H, Ishibashi Y. Eruptive vellus hair cysts with sebaceous glands. Br J Dermatol. Nov 1991;125(5):475-6. [Medline].

  35. Requena L, Sánchez Yus E. Follicular hybrid cysts. An expanded spectrum. Am J Dermatopathol. Jun 1991;13(3):228-33. [Medline].

  36. Stiefler RE, Bergfeld WF. Eruptive vellus hair cysts--an inherited disorder. J Am Acad Dermatol. Oct 1980;3(4):425-9. [Medline].

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Further Reading

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Keywords

follicular papules, vellus cyst, eruptive cyst, EVHC, vellus hair follicle abnormality, acneiform eruption, pachyonychia congenita, hidrotic ectodermal dysplasia, steatocystoma multiplex, epidermoid cysts, hybrid cysts

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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.

Medical Editor

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.

Pharmacy Editor

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
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: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

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.

CME Editor

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 None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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