Trichostasis Spinulosa Clinical Presentation

  • Author: Stephen J Krivda, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jun 7, 2010
 

History

In most cases the condition, does not lead to any subjective complaint, and trichostasis spinulosa may be noticed only as an incidental finding. Pruritus is occasionally present, as is roughness of the skin. Pruritus may be more common when lesions are present on the trunk and arms of young adults.

No report predisposing conditions are reported, although trichostasis spinulosa is more common among older patients. In younger patients, the chief complaint may be cosmetic concern about lesions on the face.

Trichostasis spinulosa lesions are frequently confused with open comedones, and patients may report a history of unsuccessful treatment for acne (eg, acne vulgaris).

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Physical

Pertinent physical findings of trichostasis spinulosa are limited to the skin. Because spinous plugs may be inapparent to the naked eye, examination of suspected lesions under a hand lens is recommended. Note the following:

  • Primary lesion: Lesions typically appear as elevated, dark, follicular plugs or papules. The lesions may have protruding tufts or spines of fine hair that can easily be removed with a comedo extractor or small-toothed forceps without discomfort to the patient. The horny plugs are soft and contain 5-25 hairs per plug. Scales may sometimes be present. Note the image below. Small, dark, follicular papules on the nose. Small, dark, follicular papules on the nose.
  • Distribution: Lesions may occur anywhere on the body, but they characteristically appear on the face, especially the nose, and the upper part of the trunk and arms, especially the interscapular area. Lesions less typically appear on other areas of the head, neck, and cheeks.
  • Color: Lesions are characteristically smaller than 1 mm. Lesions are characteristically black, follicular papules.
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Causes

The cause is unknown.

Various explanations for the hyperkeratosis and plugging of the follicular apparatus are proposed. Internal mechanisms, such as endocrine or metabolic disturbances, are suggested. Widespread trichostasis spinulosus has been reported with renal failure.[1] External mechanisms include the use of irritating soaps or paraffin-containing creams and prolonged exposure to dust, hydrocarbons, or industrial oils. Trichostasis spinulosa has also been associated with prolonged use of clobetasol.[2]

Some consider trichostasis spinulosa to be a variant of the comedonal lesions of acne; they note the similar distribution of lesions and the rarity of trichostasis spinulosa among preadolescent patients.

Microorganisms are also suggested to have a causative role. Propionibacterium acnes and Pityrosporum species are implicated as possible organisms.

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Contributor Information and Disclosures
Author

Stephen J Krivda, MD  Assistant Professor of Dermatology, Uniformed Services University of the Health Sciences; Chief of the Integrated Department of Dermatology, Chief of Dermatology Service, Director of Dermatopathology, Staff Dermatopathologist, Walter Reed Army Medical Center; Head, Department of Dermatology, Staff Dermatologist and Dermatopathologist, National Naval Medical Center

Stephen J Krivda, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

George E vonHilsheimer, MD  Assistant Professor of Dermatology, Uniformed Services University of the Health Sciences; Chief, Staff Dermatologist, Department of Medicine, Martin Army Community Hospital, Fort Benning, Georgia

George E vonHilsheimer, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, and Association of Military Dermatologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Leonard Sperling, MD  Chair, Professor, Department of Dermatology, Uniformed Services University of the Health Sciences

Leonard Sperling, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

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

  1. Sidwell RU, Francis N, Bunker CB. Diffuse trichostasis spinulosa in chronic renal failure. Clin Exp Dermatol. Jan 2006;31(1):86-8. [Medline].

  2. Janjua SA, McKoy KC, Iftikhar N. Trichostasis spinulosa: possible association with prolonged topical application of clobetasol propionate 0.05% cream. Int J Dermatol. Sep 2007;46(9):982-5. [Medline].

  3. Harford RR, Cobb MW, Miller ML. Trichostasis spinulosa: a clinical simulant of acne open comedones. Pediatr Dermatol. Nov-Dec 1996;13(6):490-2. [Medline].

  4. Pozo L, Bowling J, Perrett CM, Bull R, Diaz-Cano SJ. Dermoscopy of trichostasis spinulosa. Arch Dermatol. Aug 2008;144(8):1088. [Medline].

  5. Elston DM, White LC. Treatment of trichostasis spinulosa with a hydroactive adhesive pad. Cutis. Jul 2000;66(1):77-8. [Medline].

  6. Manuskiatti W, Tantikun N. Treatment of trichostasis spinulosa in skin phototypes III, IV, and V with an 800-nm pulsed diode laser. Dermatol Surg. Jan 2003;29(1):85-8. [Medline].

  7. Toosi S, Ehsani AH, Noormohammadpoor P, Esmaili N, Mirshams-Shahshahani M, Moineddin F. Treatment of trichostasis spinulosa with a 755-nm long-pulsed alexandrite laser. J Eur Acad Dermatol Venereol. Sep 23 2009;[Medline].

 
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Small, dark, follicular papules on the nose.
Biopsy specimen demonstrates a dilated follicle that contains numerous vellus hairs and keratin debris.
Potassium hydroxide mount of an extracted plug reveals multiple vellus hairs embedded in keratinous material.
 
 
 
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