Eruptive Vellus Hair Cysts Treatment & Management

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

Medical Care

Twenty-five percent of eruptive vellus hair cyst (EVHC) cases resolve spontaneously through transepidermal elimination.

Keratolytic treatment is as follows:

  • Clinical benefit was reported after gentle mechanical dermabrasion with an exfoliating sponge (eg, Buf Puf, 3M; St. Paul, Minn) followed by an application of 10% urea cream.
  • Significant clinical improvement resulted in one case with 12% lactic acid applied to the affected areas.

Retinoid treatment is as follows:

  • Topical tretinoin applied nightly to the affected area is a reasonably safe treatment option. This method reportedly cleared a case of congenital EVHC after only 5 applications, leaving only a slight residual erythema that gradually faded.
  • Topical tazarotene cream 0.1% applied to the affected area was shown to be more effective than some surgical options for the treatment of EVHC.[15]
  • Oral isotretinoin at 1 mg/kg/d produced no improvement in one patient after 20 weeks of therapy.[16]
  • Systemic vitamin A therapy (100,000 IU/d) has also been tried; however, this also produced no clinical improvement and resulted in severe headaches requiring discontinuation of therapy.

Calcipotriene treatment has been reported. A single case report showed a partial response of EVHCs after a 2 months treatment course with topical calcipotriene.[17]

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Surgical Care

Needle evacuation of eruptive vellus hair cysts (EVHCs) can be performed using an 18-gauge needle after local anesthesia with a topical anesthetic (EMLA cream).[18] This technique can also be used to aid in the diagnosis of EVHC. After extrusion, the cyst is examined histologically, pressed between a glass slide and cover slip with mineral oil. Multiple thin, fine hairs can be seen within the lumen of the thin cyst wall.

Simple excision (eg, punch biopsy technique) removes the cyst; however, this is not practical for most cases of EVHCs because the cysts are too numerous and punch biopsy scars may be unsightly.

Carbon dioxide laser vaporization has been effective for a case of EVHC on the face.[19] A test spot was performed with the carbon dioxide laser (10,600-nm wavelength) at 5 watts of power, irradiance of 160 W/cm2, a 2-mm spot size, and a pulse duration of 0.2 seconds. No scarring occurred after treating the face in the same manner. Eyelid lesions were treated in the same manner except they used only 3 watts of power and 100 W/cm2 irradiance. Slight hyperpigmentation occurred at some of the treated sites; no hypertrophic scarring was noted. Cystic regeneration did not occur.

Pulsed erbium:yttrium-aluminum-garnet (Er:YAG) laser has been reported effective in treating 2 patients with EVHCs on the trunk.[20] The technique involved drilling with the Er:YAG laser (2940-nm wavelength) using a 2-mm spot size, 250-microsecond pulse duration at 60.5-63.7 J/cm2, and a 1.9- to 2-J pulse energy. Three to 5 stacked pulses were delivered, the cysts were expressed with digital pressure, they were extracted with forceps, the base of the cyst wall was further ablated with 3 pulses, and the area was allowed to heal by secondary intention. The follow-up evaluation was performed only by telephone interview; patients reported no scarring, discoloration, or recurrence of the cysts. However, another report has suggested early recurrence of the cysts after treatment with Er:YAG laser to EVHC on the face.[21]

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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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  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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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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