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Trichostasis Spinulosa Workup

  • Author: Nicholas V Nguyen, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Feb 02, 2015
 

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The diagnosis of trichostasis spinulosa (TS) can be made clinically without obtaining a biopsy specimen. If the diagnosis is in doubt, a specimen may easily be obtained by removing a hair plug with a forceps or comedone extractor. The specimen may be placed on a glass slide for microscopic examination. Treatment with potassium hydroxide dissolves the keratinous plug, leaving numerous vellus hairs in a characteristic tuft. Dermatoscopy may also be used to help confirm the diagnosis.[4]

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Histologic Findings

If a biopsy specimen is obtained, histology reveals a dilated hair follicle housing multiple vellus hairs in a keratotic sheath and acanthosis of the follicular epithelium (see the images below). Inflammatory changes are not a characteristic of trichostasis spinulosa.

Biopsy specimen demonstrates a dilated follicle thBiopsy specimen demonstrates a dilated follicle that contains numerous vellus hairs and keratin debris.
Potassium hydroxide mount of an extracted plug revPotassium hydroxide mount of an extracted plug reveals multiple vellus hairs embedded in keratinous material.
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Contributor Information and Disclosures
Author

Nicholas V Nguyen, MD Resident Physician, Department of Dermatology, Children's Hospital Colorado, Denver Health Medical Center, University of Colorado Hospital, VA Eastern Colorado

Nicholas V Nguyen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, International Society of Dermatology, Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Tracy Funk, MD Fellow in Pediatric Dermatology, Department of Dermatology, The Children’s Hospital Colorado

Tracy Funk, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Academy of Pediatrics, Society for Pediatric Dermatology, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

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

Disclosure: Nothing to disclose.

Jaggi Rao, MD, FRCPC Clinical Professor of Medicine, Division of Dermatology and Cutaneous Sciences, Director of Dermatology Residency Program, University of Alberta Faculty of Medicine and Dentistry

Jaggi Rao, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, Canadian Medical Association, Pacific Dermatologic Association, Royal College of Physicians and Surgeons of Canada, Canadian Medical Protective Association, Canadian Dermatology Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

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.

Acknowledgements

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.

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.

References
  1. Sidwell RU, Francis N, Bunker CB. Diffuse trichostasis spinulosa in chronic renal failure. Clin Exp Dermatol. 2006 Jan. 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. 2007 Sep. 46(9):982-5. [Medline].

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

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

  5. Elston DM, White LC. Treatment of trichostasis spinulosa with a hydroactive adhesive pad. Cutis. 2000 Jul. 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. 2003 Jan. 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. 2009 Sep 23. [Medline].

  8. Badawi A, Kashmar M. Treatment of trichostasis spinulosa with 0.5-millisecond pulsed 755-nm alexandrite laser. Lasers Med Sci. 2011 Nov. 26(6):825-9. [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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