eMedicine Specialties > Dermatology > Diseases of the Adnexa

Trichostasis Spinulosa

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
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
Contributor Information and Disclosures

Updated: Nov 12, 2008

Introduction

Background

In trichostasis spinulosa (TS), clusters of vellus hairs become embedded within hair follicles, with resultant elevated, dark, spiny papules on the face or trunk. Trichostasis spinulosa frequently is discovered as an incidental finding, and often it is confused with keratosis pilaris or acne comedones.

Pathophysiology

Trichostasis spinulosa results from successive production and retention of vellus telogen club hairs from a single hair matrix in a follicle. Hyperkeratosis plugs the follicle and results in the retention of the vellus hairs in the obstructed follicular infundibulum. The precise cause of this phenomenon remains undetermined.

Frequency

United States

To the authors' knowledge, studies of prevalence have not been undertaken, but published reports indicate that the condition is common, especially in elderly persons.

Mortality/Morbidity

  • Trichostasis spinulosa is primarily a cosmetic concern.
  • Trichostasis spinulosa does not cause morbidity.
  • The condition may become more severe with age.

Sex

Most reports state that trichostasis spinulosa more frequently affects male patients, but it may occur equally in men and women.

Age

Rarely, cases are reported in children, but the condition nearly always occurs in adults, especially older adults.

Clinical

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).

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.

  • Skin - 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.
  • Skin - 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.
  • Skin - Color
    • Lesions are characteristically smaller than 1 mm.
    • Lesions are characteristically black, follicular papules.

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.

More on Trichostasis Spinulosa

Overview: Trichostasis Spinulosa
Differential Diagnoses & Workup: Trichostasis Spinulosa
Treatment & Medication: Trichostasis Spinulosa
Follow-up: Trichostasis Spinulosa
Multimedia: Trichostasis Spinulosa
References
[ CLOSE WINDOW ]

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

  5. 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].

  6. Chung TA, Lee JB, Jang HS, Kwon KS, Oh CK. A clinical, microbiological, and histopathologic study of trichostasis spinulosa. J Dermatol. Nov 1998;25(11):697-702. [Medline].

  7. Ladany E. Trichostasis spinulosa. J Invest Dermatol. Jul 1954;23(1):33-41. [Medline].

  8. Requena L, Sánchez Yus E. Trichostasis spinulosa within an intradermal melanocytic nevus. Cutis. Sep 1991;48(3):211-2. [Medline].

  9. Strobos MA, Jonkman MF. Trichostasis spinulosa: itchy follicular papules in young adults. Int J Dermatol. Oct 2002;41(10):643-6. [Medline].

  10. White SW, Rodman OG. Trichostasis spinulosa. J Natl Med Assoc. Jan 1982;74(1):31-3. [Medline].

  11. Young MC, Jorizzo JL, Sanchez RL, Hebert AA, Thomas DR, King CA. Trichostasis spinulosa. Int J Dermatol. Nov 1985;24(9):575-80. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

TS, vellus hairs, keratosis pilaris, acne comedones, open comedones

[ CLOSE WINDOW ]

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
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.

Medical Editor

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.

Pharmacy Editor

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.

Managing Editor

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.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine 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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.