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LETTER TO EDITOR
Year : 2011  |  Volume : 3  |  Issue : 1  |  Page : 44-45  

Trichostasis spinulosa presenting as itchy papules in a young lady


Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra, India

Date of Web Publication16-Jun-2011

Correspondence Address:
Mani Anand
Department of Pathology, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Off Pune-Mumbai Bypass, Pune - 411 041, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7753.82126

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How to cite this article:
Deshmukh SD, Anand M, Yadav GE, Joshi AR. Trichostasis spinulosa presenting as itchy papules in a young lady. Int J Trichol 2011;3:44-5

How to cite this URL:
Deshmukh SD, Anand M, Yadav GE, Joshi AR. Trichostasis spinulosa presenting as itchy papules in a young lady. Int J Trichol [serial online] 2011 [cited 2020 Sep 24];3:44-5. Available from: http://www.ijtrichology.com/text.asp?2011/3/1/44/82126

Sir,

A 27-year-old woman of South Asian descent presented with gradually erupting itchy papules and open pores behind her left ear for the past 1 month. Her past medical or family history was unremarkable. Physical examination revealed multiple dark brown keratotic cystic plaques and comedones behind her left ear. A skin biopsy was taken from the representative area and sent for histopathological examination. Light microscopy revealed three cystically dilated hair follicles with retention of small hair shafts and keratinous material within the dermis. Perifollicular mononuclear cell infiltration was evident [Figure 1] and [Figure 2]. Based on the above features, a diagnosis of Trichostasis Spinulosa (TS) was offered. The patient was started on 0.05% tretinoin cream to be applied over the affected area daily at bedtime, and was also given oral antihistaminics to relieve the itching. A marked improvement of the lesions was seen at the 3-month follow-up.
Figure 1: Photomicrograph revealing three cystically dilated hair follicles within the dermis (H and E, ×100)

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Figure 2: Dilated hair follicle with retention of small hair shafts and keratinous material. Perifollicular chronic inflammatory infiltrate is also evident (H and E, ×400)

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TS is a relatively common but underdiagnosed disorder of the pilosebaceous follicles, in which there is follicular hyperkeratosis of a dilated vellus hair follicle with retention of successive telogen hairs arranged in parallel among the keratinaceous material. [1] It presents as raised follicular spicules or as open comedones on the face, nose or cheeks of middle-aged and older individuals, and may be pruritic. [2] The etiology of TS is not known for certain. Congenital dysplasia of the hair follicles as well as external factors such as dust, oils, ultraviolet light, heat and irritants have been proposed. According to one of the hypotheses, hair shaft entrapment is the result of hyperkeratosis in the follicular infundibulum thus producing an obstruction to the normal hair shedding. [3] Topical treatments offer temporary relief, but permanent removal of the abnormal follicles using hair removal lasers may result in a definite cure. [4]

 
   References Top

1.Sidwell RU, Francis N, Bunker CB. Diffuse trichostasis spinulosa in chronic renal failure. Clin Exp Dermatol 2006;31:86-8.   Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2. Harford RR, Cobb MW, Miller ML. Trichostasis spinulosa: a clinical simulant of acne open comedones. Pediatr Dermatol 1996;13:490-2.   Back to cited text no. 2
[PUBMED]    
3. Ioffreda MD. Inflammatory diseases of hair follicles, sweat glands, and cartilage. In: Elder DE, Elenitsas R, Johnson BL, Murphy GF, Editors. Lever's Histopathology of the Skin. 9th ed. Philadelphia: Lippincott, Williams and Wilkins; 2005. p. 469-512.  Back to cited text no. 3
    
4.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 2010;24:470-3.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2]


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