Eruptive Vellus Hair Cysts: Background, Pathophysiology, Etiology

Sections

Overview

Background

Eruptive vellus hair cysts (EVHCs) were first described in 1977 by Esterly and colleagues who reported 2 children with symmetrically distributed follicular papules on the chest and flexor extremities.^[1]Histologically, these papules had the unique characteristic of dermal cysts containing small vellus hairs.^[2]

Cases of EVHC may either be acquired or inherited in an autosomal dominant fashion. Generally, they are isolated findings. However, they have been associated with other skin disorders (eg, anhidrotic ectodermal dysplasia, hidrotic ectodermal dysplasia, pachyonychia congenita).

Pathophysiology

Eruptive vellus hair cysts (EVHCs) are thought to arise as a developmental abnormality of vellus hair follicles. A predisposition exists for follicular occlusion at the level of the infundibulum, which results in cystic dilatation of the proximal hair follicle and secondary atrophy of the hair bulb.^[3]

It has been reported after application of minoxidil.^[4]

Etiology

Eruptive vellus hair cysts (EVHCs) occur as a developmental abnormality of vellus hair follicles. A gradual disruption occurs between the proximal and distal parts of the follicle, usually at the level of the infundibulum. This results in the retention of hairs, cystic dilatation of the proximal follicle, and subsequent atrophy of the hair bulb.

EVHCs have also been considered a type of follicular hamartoma. The cyst wall may consist of keratinization patterns from different levels of the follicular infundibulum. The keratinization is generally that of the epidermis or the outer root sheath, but foci of trichilemmal keratinization have also been reported.

Frequency

The frequency is unknown. More than 50 cases have been reported in the literature; however, eruptive vellus hair cysts (EVHCs) may occur more frequently than is suggested by reports, possibly because the diagnosis is only definitively confirmed with biopsy.

Race

Eruptive vellus hair cysts (EVHCs) have no racial predilection.

Sex

Males and females are affected equally.

Age

In familial cases, eruptive vellus hair cysts (EVHCs) are first noted at birth or during infancy. In sporadic cases, cysts usually develop in the late-first or second decade of life.

Prognosis

Eruptive vellus hair cysts (EVHCs) are asymptomatic; however, they may be cosmetically bothersome. Morbidity may be associated with treatment of the disorder. Lesions may resolve spontaneously via transepidermal elimination of cyst contents.

Clinical Presentation

Esterly NB, Fretzin DF, Pinkus H. Eruptive vellus hair cysts. Arch Dermatol. 1977 Apr. 113(4):500-3. [Medline].
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. [Medline].
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. [Medline].
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. [Medline].
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. [Medline].
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. [Medline].
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. [Medline].
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. [Medline].
Benoldi D, Allegra F. Congenital eruptive vellus hair cysts. Int J Dermatol. 1989 Jun. 28(5):340-1. [Medline].
Mayron R, Grimwood RE. Familial occurrence of eruptive vellus hair cysts. Pediatr Dermatol. 1988 May. 5(2):94-6. [Medline].
Rodgers SA, Kitagawa K, Selim MA, Bellet JS. Familial eruptive vellus hair cysts. Pediatr Dermatol. 2012 May. 29(3):367-9. [Medline].
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. [Medline].
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. [Medline].
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. [Medline].
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. [Medline].
Lee HT, Chang SH, Yoon TY. Eruptive vellus hair cyst in a patient with pachyonychia congenita. J Dermatol. 1999 Jun. 26(6):402-4. [Medline].
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. [Medline].
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. [Medline].
Köse O, Tastan HB, Deveci S, Gür AR. Anhidrotic ectodermal dysplasia with eruptive vellus hair cysts. Int J Dermatol. 2001 Jun. 40(6):401-2. [Medline].
Mieno H, Fujimoto N, Tajima S. Eruptive vellus hair cyst in patients with chronic renal failure. Dermatology. 2004. 208(1):67-9. [Medline].
Morgan MB, Kouseff BG, Silver A, et al. Eruptive vellus hair cysts and neurologic abnormalities: two related conditions?. Cutis. 1991 Jun. 47(6):413-5. [Medline].
Nandedkar MA, Minus H, Nandedkar MA. Eruptive vellus hair cysts in a patient with Lowe syndrome. Pediatr Dermatol. 2004 Jan-Feb. 21(1):54-7. [Medline].
Kaya TI, Tataroglu C, Tursen U, Ikizoglu G. Eruptive vellus hair cysts: an effective extraction technique for treatment and diagnosis. J Eur Acad Dermatol Venereol. 2006 Mar. 20(3):264-8. [Medline].
Alfaro-Castellon P, Mejia-Rodriguez SA, Valencia-Herrera A, Ramírez S, Mena-Cedillos C. Dermoscopy Distinction of Eruptive Vellus Hair Cysts with Molluscum Contagiosum and Acne Lesions. Pediatr Dermatol. 2012 May 29. [Medline].
Panchaprateep R, Tanus A, Tosti A. Clinical, dermoscopic, and histopathologic features of body hair disorders. J Am Acad Dermatol. 2015 May. 72 (5):890-900. [Medline].
Kiene P, Hauschild A, Christophers E. Eruptive vellus hair cysts and steatocystoma multiplex. variants of one entity?. Br J Dermatol. 1996 Feb. 134(2):365-7. [Medline].
Zaharia D, Kanitakis J. Eruptive vellus hair cysts: report of a new case with immunohistochemical study and literature review. Dermatology. 2012. 224(1):15-9. [Medline].
Tomková H, Fujimoto W, Arata J. Expression of keratins (K10 and K17) in steatocystoma multiplex, eruptive vellus hair cysts, and epidermoid and trichilemmal cysts. Am J Dermatopathol. 1997 Jun. 19(3):250-3. [Medline].
Ahn SK, Chung J, Lee WS, Lee SH, Choi EH. Hybrid cysts showing alternate combination of eruptive vellus hair cyst, steatocystoma multiplex, and epidermoid cyst, and an association among the three conditions. Am J Dermatopathol. 1996 Dec. 18(6):645-9. [Medline].
Jerasutus S, Suvanprakorn P, Sombatworapat W. Eruptive vellus hair cyst and steatocystoma multiplex. J Am Acad Dermatol. 1989 Feb. 20(2 Pt 1):292-3. [Medline].
Ohtake N, Kubota Y, Takayama O, Shimada S, Tamaki K. Relationship between steatocystoma multiplex and eruptive vellus hair cysts. J Am Acad Dermatol. 1992 May. 26(5 Pt 2):876-8. [Medline].
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].
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. 1987 Mar. 116(3):465-6. [Medline].
Erkek E, Kurtipek GS, Duman D, Sanli C, Erdogan S. Eruptive vellus hair cysts: report of a pediatric case with partial response to calcipotriene therapy. Cutis. 2009 Dec. 84(6):295-8. [Medline].
Sárdy M, Kárpáti S. Needle evacuation of eruptive vellus hair cysts. Br J Dermatol. 1999 Sep. 141(3):594-5. [Medline].
Huerter CJ, Wheeland RG. Multiple eruptive vellus hair cysts treated with carbon dioxide laser vaporization. J Dermatol Surg Oncol. 1987 Mar. 13(3):260-3. [Medline].
Kageyama N, Tope WD. Treatment of multiple eruptive hair cysts with erbium:YAG laser. Dermatol Surg. 1999 Oct. 25(10):819-22. [Medline].
Coras B, Hohenleutner U, Landthaler M, Hohenleutner S. Early recurrence of eruptive vellus hair cysts after Er:YAG laser therapy: case report and review of the literature. Dermatol Surg. 2005 Dec. 31(12):1741-4. [Medline].
Helbig D, Bodendorf MO, Grunewald S, et al. Comparative treatment of multiple vellus hair cysts with the 2940 nm Er:YAG and 1540 nm Er:Glass laser. J Cosmet Laser Ther. 2011 Oct. 13(5):223-6. [Medline].

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

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