History

Eruptive vellus hair cysts (EVHCs) typically develop as an acneiform eruption on the chest and extremities.^[5]EVHCs have also been reported on the eyelids and periorbital skin,as well as the labium major.^{[6, 7, 8, 9]}Often, no antecedent trauma or triggering factor is reported. EVHCs may be congenital or acquired. Several reports have noted familial cases in which the condition is thought to be inherited as an autosomal dominant trait.^{[10, 11, 12]}EVHCs may be present at birth or arise in childhood. In sporadic cases, lesions typically arise in the first and second decades with the onset of puberty.

Physical Examination

Eruptive vellus hair cysts (EVHCs) appear clinically as discrete follicular papules. Papules may appear erythematous, yellow, bluish-gray, or even slightly brown. The chest and flexor or extensor surfaces of the extremities are the most common sites of involvement. Generalized EVHCs and facial variants are reported. EVHCs may also be seen on the ears.^[13]A single case report describes unilateral EVHCs of the face.^[14]

Patients may have just a few cysts, or, often, they may have several hundred. More than 400 cysts were seen on a patient with generalized EVHC. Cysts are usually dome-shaped with a smooth surface, measuring 1-4 mm in diameter. Cysts sometimes demonstrate central puncta, hyperkeratotic crusts, or umbilication. Mechanical irritation of the cysts may produce transepidermal elimination of retained vellus hairs, similar to that seen in perforating folliculitis.

Note the images below.

Clinical photo of eruptive vellus hair cysts showing involvement on the patient's chest.

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Eruptive vellus hair cysts in the axilla.

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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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Differential Diagnoses

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Anand P, Sarin N, Misri R, Khurana VK. Eruptive Vellus Hair Cyst: An Uncommon and Underdiagnosed Entity. Int J Trichology. 2018 Jan-Feb. 10 (1):31-33. [QxMD MEDLINE Link].
Shi G, Zhou Y, Cai YX, Li SJ, Fan YM. Clinicopathological features and expression of four keratins (K10, K14, K17 and K19) in six cases of eruptive vellus hair cysts. Clin Exp Dermatol. 2014 Jun. 39 (4):496-9. [QxMD MEDLINE Link].
Eun DH, Kim SM, Jang YH, Lee SJ, Kim DW, Lee WJ. Facial Eruptive Vellus Hair Cysts Occurred after 3% Minoxidil Application. Ann Dermatol. 2018 Feb. 30 (1):95-96. [QxMD MEDLINE Link].
Binhlam JQ, Gross AS, Onadeko OO, Dutt PL, King LE Jr. Acneiform eruption due to eruptive vellus hair cysts. South Med J. 1992 Mar. 85(3):322-5. [QxMD MEDLINE Link].
Reep MD, Robson KJ. Eruptive vellus hair cysts presenting as multiple periorbital papules in a 13-year-old boy. Pediatr Dermatol. 2002 Jan-Feb. 19(1):26-7. [QxMD MEDLINE Link].
Park JH, Her Y, Chun BM, Kim CW, Kim SS. A case of eruptive vellus hair cysts that developed on the labium major. Ann Dermatol. 2009 Aug. 21(3):294-6.
Choi R, MacLean KD, Davidson HC, Patel BC. Vellus Hair Cyst of the Orbit. Ophthal Plast Reconstr Surg. 2015 Apr 8. [QxMD MEDLINE Link].
Jakobiec FA, Stagner AM, Freitag SK, Yoon MK. Unusual Eyelid Dermal Keratinous Cysts of Pilosebaceous Origin. Ophthal Plast Reconstr Surg. 2016 Mar-Apr. 32 (2):93-7. [QxMD MEDLINE Link].
Benoldi D, Allegra F. Congenital eruptive vellus hair cysts. Int J Dermatol. 1989 Jun. 28(5):340-1. [QxMD MEDLINE Link].
Mayron R, Grimwood RE. Familial occurrence of eruptive vellus hair cysts. Pediatr Dermatol. 1988 May. 5(2):94-6. [QxMD MEDLINE Link].
Rodgers SA, Kitagawa K, Selim MA, Bellet JS. Familial eruptive vellus hair cysts. Pediatr Dermatol. 2012 May. 29(3):367-9. [QxMD MEDLINE Link].
Yanik ME, Aliagaoglu C, Güvenç SC, Yildirim U, Albayrak H. Eruptive vellus hair cysts occurring on the ears. J Dermatol. 2009 Jun. 36(6):360-1. [QxMD MEDLINE Link].
Lew BL, Lee MH, Haw CR. Unilateral eruptive vellus hair cysts occurring on the face. J Eur Acad Dermatol Venereol. 2006 Nov. 20(10):1314-6. [QxMD MEDLINE Link].
Chan KH, Tang WY, Lam WY, Lo KK. Eruptive vellus hair cysts presenting as bluish-grey facial discoloration masquering as naevus of Ota. Br J Dermatol. 2007 Jul. 157(1):188-9. [QxMD MEDLINE Link].
Li Y, Shan SJ, Luo S, Zhang S, Liu Q. Eruptive vellus hair cysts in association with syringomas. Eur J Dermatol. 2012 May-Jun. 22(3):394-5. [QxMD MEDLINE Link].
Lee HT, Chang SH, Yoon TY. Eruptive vellus hair cyst in a patient with pachyonychia congenita. J Dermatol. 1999 Jun. 26(6):402-4. [QxMD MEDLINE Link].
Takeshita T, Takeshita H, Irie K. Eruptive vellus hair cyst and epidermoid cyst in a patient with pachyonychia congenita. J Dermatol. 2000 Oct. 27(10):655-7. [QxMD MEDLINE Link].
Romiti R, Festa Neto C. Eruptive vellus hair cysts in a patient with ectodermal dysplasia. J Am Acad Dermatol. 1997 Feb. 36(2 Pt 1):261-2. [QxMD MEDLINE Link].
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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. [QxMD MEDLINE Link].
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Media Gallery

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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Author

Stephanie Juliet Campbell, DO Chief Resident Physician, Tri-County Dermatology

Stephanie Juliet Campbell, DO is a member of the following medical societies: American Academy of Dermatology, American Osteopathic College of Dermatology, American Society for Dermatologic Surgery, American Society of Dermatopathology, Cleveland Dermatological Society, Ohio Dermatological Association, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Nicholas V Nguyen, MD Director of Pediatric Dermatology, Akron Children's Hospital

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Society for Investigative Dermatology

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

Cory A Dunnick, MD Associate Professor, Director of Contact Dermatitis Clinic, Director of Medical Student Education, Department of Dermatology, University of Colorado Denver School of Medicine

Cory A Dunnick, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, Women's Dermatologic Society, American Contact Dermatitis Society

Disclosure: Nothing to disclose.

Harry Dao, Jr, MD Assistant Professor, Department of Dermatology, Baylor College of Medicine

Harry Dao, Jr, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Eruptive Vellus Hair Cysts Clinical Presentation

History

Physical Examination

References

Tables

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