Eruptive Vellus Hair Cysts

Updated: Jul 29, 2019
  • Author: Stephanie Juliet Campbell, DO; Chief Editor: Dirk M Elston, MD  more...
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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).



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]



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.




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.


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


Males and females are affected equally.


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.



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.