Eruptive Vellus Hair Cysts Workup

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

Procedures

Punch biopsy of the skin is the diagnostic procedure of choice for eruptive vellus hair cysts (EVHCs).

Alternatively, the diagnosis can be confirmed with a potassium hydroxide wet mount of cyst contents extruded through a small incision. Microscopic examination of the cyst contents reveals vellus hairs. The cyst can be anesthetized with a local or topical anesthetic prior to incision with a sterile blade or 18-gauge needle.

In 2006, another extraction technique was described. Patients were treated with topical anesthetic prior to puncturing the surface of the cyst with a sharp-tipped electrocautery instrument. The cyst wall and contents were then dissected out with forceps and either sent to a pathology laboratory or examined microscopically with 10% potassium hydroxide to confirm the diagnosis of EVHC.[9]

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Histologic Findings

Histopathology of eruptive vellus hair cysts (EVHCs) shows a cystic structure in the mid dermis arising from the infundibulum of a hair follicle. The cysts contain multiple cross-sections of vellus hairs and layered laminated keratinous material. They are lined by squamous epithelium 2- to 5-cells thick. Generally, no sebaceous glands are present in the cyst wall. A surrounding granulomatous reaction may be present, especially if the hairs disrupt the cyst wall.

The differential diagnosis of pilosebaceous cysts includes infundibular cysts, steatocystoma multiplex, and EVHCs. All 3 commonly affect the anterior chest and consist of asymptomatic papules or nodules. Obstructed or occluded follicles form the common infundibular cysts. These do not contain sebaceous glands or vellus hairs. The cysts of steatocystoma multiplex arise in the sebaceous duct and have a crenulated, eosinophilic, hyaline lining to the cyst wall where the granular layer is absent. Steatocystomas also contain sebaceous glands arising within the cyst wall.

Some authors believe that EVHC and steatocystoma multiplex are variants of the same disorder because both lesions have been reported in the same patient.[10] Other authors have defended their status as distinct entities based on different histologic patterns. One study[11] demonstrated differential expression of keratins 10 and 17. In 2 cases of EVHC, there was strong staining for K17 but no staining for K10. In 7 cases of steatocystoma, both K10 and K17 were expressed in the suprabasal cells of the cyst wall. In 5 epidermoid cysts, positive staining occurred only for K10.

Several reports note patients having cysts containing elements of both EVHCs and steatocystoma multiplex.[12, 13, 14] The term hybrid cyst has been proposed to describe cysts containing combinations of EVHCs, steatocystoma multiplex, and epidermoid cysts. Some authorities argue that these cyst types all form from the pilosebaceous unit and are therefore all just a spectrum of the same disorder. Combinations of infundibular cysts, trichilemmal cysts, and pilomatricomas have also been described as hybrid cysts.

Note the images below.

Histopathology of an eruptive vellus hair cyst shoHistopathology of an eruptive vellus hair cyst showing a middermal cyst with squamous epithelium. A close-up view of the contents of an eruptive velA close-up view of the contents of an eruptive vellus hair cyst showing cross-sections of vellus hairs and laminated keratinous material.
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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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  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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  22. 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].

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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].

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

  27. 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].

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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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