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| CASE REPORT |
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| Year : 2020 | Volume
: 12
| Issue : 2 | Page : 79-81 |
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Anterior ectopic cilia with myopia and lichen nitidus: A rare case report with dermoscopic findings
Alpana Mohta1, Aditi Agrawal1, Pritee Sharma1, Ramesh Kumar Kushwaha1, Rajeev Saxena2, Rekha Mohta3, Suresh Kumar Jain1
1 Department of Dermatology, Venereology and Leprosy, GMC, Kota, Rajasthan, India
2 Department of Pathology, GMC, Kota, Rajasthan, India
3 Department of Ophthalmology, SDM Government Satellite Hospital, Bikaner, Rajasthan, India
| Date of Submission | 07-Mar-2020 |
| Date of Decision | 17-Mar-2020 |
| Date of Acceptance | 08-Apr-2020 |
| Date of Web Publication | 05-May-2020 |
Correspondence Address:
Suresh Kumar Jain
Department of Dermatology, Venereology and Leprosy, GMC, Kota - 324 005, Rajasthan
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijt.ijt_29_20
 Abstract | | |
Ectopic cilia, or lash follicles situated over abnormal sites, are an extremely rare entity. Here, we report the case of a 6-year-old-boy who presented with ectopic cilia over the left upper eyelid along with a positive family history. Dermoscopy revealed discreet terminal hair emerging from the individual hair follicles surmounted over a diffuse structureless whitish-yellow zone and a few vellus hairs in the surrounding normal skin. These hairs, on histopathological examination, had multiple pilosebaceous follicular units embedded in a desmoplastic stroma with multiple eccrine sweat glands. Other incidental findings included lichen nitidus and myopia.
Keywords: Anterior ectopic cilia, dermoscopic findings, lichen nitidus, myopia
How to cite this article:
Mohta A, Agrawal A, Sharma P, Kushwaha RK, Saxena R, Mohta R, Jain SK. Anterior ectopic cilia with myopia and lichen nitidus: A rare case report with dermoscopic findings. Int J Trichol 2020;12:79-81 |
How to cite this URL:
Mohta A, Agrawal A, Sharma P, Kushwaha RK, Saxena R, Mohta R, Jain SK. Anterior ectopic cilia with myopia and lichen nitidus: A rare case report with dermoscopic findings. Int J Trichol [serial online] 2020 [cited 2023 May 30];12:79-81. Available from: https://www.ijtrichology.com/text.asp?2020/12/2/79/283805 |
| Introduction | |  |
Under normal circumstances, cilia or eyelashes are located only over the margin of the eyelid. However, a large number of congenital and acquired diseases can affect the cilia. Various congenital ciliary abnormalities include cilia incarnate, agenesis, duplicate ciliary row, and ectopic cilia. Ectopic cilium is the rarest anomaly among them all. Ectopic or accessory cilia are the lash follicles situated over an abnormal site. They exists in two forms, namely anterior and posterior.[1]
| Case Report | | |
A 6-year-old boy presented to our outpatient department with his parents, with a complaint of the presence of a tuft of the hair over the outer aspect of the left upper eyelid since birth. On inquiry, the patient's parents admitted that the child used to keep rubbing his left eye, especially while studying or watching television. On cutaneous examination, there was a tuft of around 20–25 hairs over the left upper eyelid 8 mm superior to the lateral lid margin [Figure 1]a. These lashes were surmounted over a noninflammatory skin-colored papular base and had a similar morphology to normal eyelashes. On palpation, this group of hairs was clinging to the tarsal conjunctival plate. There was no tenderness or discharge. | Figure 1: (a) Ectopic cilia on the left upper eyelid. (b) Discreet terminal hair emerging from individual hair follicles (red arrow) surmounted over a diffuse structureless whitish-yellow zone (yellow arrow) and a few vellus hair in the surrounding normal skin (blue arrow) (Dermlite, ×10). (c) Hair microscopy showing both plucked hair follicles with normal morphology in anagen phase (red arrow – ectopic cilia; yellow arrow – normal eyelash
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While eliciting family history, the parents revealed that the child's late paternal grandfather had similar ectopic lashes over his left lid.
On dermoscopic evaluation of the cilia, there was the presence of discreet terminal hair emerging from the individual hair follicles surmounted over a diffuse structureless whitish-yellow zone and a few vellus hairs in the surrounding normal skin. There was no perifollicular hyperpigmentation, erythema, yellow/white/black dots, or sebum accumulation at the base [Figure 1]b. On microscopic evaluation, the cilia plucked from ectopic tuft and eyelid were comparable [Figure 1]c.
On general psychical examination of the rest of the body, we also observed multiple grouped shiny, 1–2 mm-sized, polygonal papules over the midline of the back and left scapular region [Figure 2]a. Differential diagnoses considered were lichen nitidus, lichen planus, atopic dermatitis, and lichen striatus. On histopathological examination of these lesions, there was the presence of dense lymphohistiocytic subepidermal infiltrate enclosed within the enlarged dermal papilla and interface reaction [Figure 2]c. Dermoscopically, multiple, white, well-circumscribed circular areas along with a vague brown shadow within the white circles [Figure 2]b. The lesions were diagnosed as lichen nitidus on the basis of their characteristic morphology and dermoscopy, which further got confirmed by histopathological examination. | Figure 2: (a) 1) Multiple lesions of lichen nitidus on the midline of the back and left scapular region, 2) close-up view. (b) Multiple, white, well-circumscribed circular areas (black arrow) along with a vague brown shadow (purple arrow) within the white circles (Dermlite, ×10). (c) Dense lymphohistiocytic subepidermal infiltrate enclosed within enlarged dermal papilla and interface reaction (H and E, ×100)
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On ophthalmological examination, normal superior and inferior palpebral conjunctiva ruled out posterior cilia. Visual acuity was 20/20 (OS) and 20/20 (OD) with −0.75 DS in the left eye.
The patient was diagnosed with ectopic cilia with myopia of the left eye and advised surgical excision. Histopathological analysis of the excised mass showed multiple pilosebaceous hair follicles embedded in a desmoplastic stroma with multiple eccrine sweat glands [Figure 3]. The presence of lichen nitidus was an incidental finding. The patient's parents were advised surgical resection of the ectopic cilia, which they refused to. | Figure 3: (a) Multiple pilosebaceous hair follicles embedded in a desmoplastic stroma with multiple eccrine sweat glands (H and E, ×100). (b) A close-up view of the eccrine glands (H and E, ×400)
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| Discussion | | |
Although common in animals,[2] ectopic cilia is a rarely reported entity in humans. It was reported for the first time by Wiegmann in 1936.[3] It exists primarily in two forms: anterior and posterior, arising from the anterior and posterior tarsal plate, respectively. Anterior ectopic cilia are congenital (hereditary or sporadic), generally asymptomatic, unilateral and seen along with the apocrine sweat glands.[4] The characteristic site of the anterior ectopic cilia corresponds to the embryological development site where the two angiosomes of temporal and facial arteries coincide (the location of the Tessier or the type 9 facial cleft).[5] They arise due to the focal absence of suppression of the periorbital natural facial hair growth from accessory eyebrow and eyelash cells.[6]
According to a theory of development, they arise from replacement of Meibomian glands with the cutaneous glands.[1] Another theory states that they are derived from the skin of eyelid with follicle bulbs embedded in the dermis (normally, the lid follicles are situated deep in the orbicular muscles).[7]
Various diseases reported being associated with it include atopic eczema, nail–patella syndrome, choristoma, and nevus depigmentosus.[[8],[9],[10],[11] The only association observed in our patient was incidental lichen nitidus with left eye myopia.
Differential diagnoses include cilia incarnate (growth of an extra eyelash from a normal origin via the eyelid to either the inner tarsal conjunctiva or external skin), dermoid cysts,[12],[13] distichiasis, and trichiasis.
All of the above were ruled out in our patient by clinical and dermascopic evaluation. The proximity of the tuft to the tarsal plate, their similarity to eyelashes, and lateral direction of cilia favored the diagnosis of anterior ectopic cilia. Dermoscopy is also helpful in ruling out the dermoid cyst (shows the presence of hair emerging from a common sinus tract instead).
To date, only 16 cases of anterior ectopic cilia have been reported in the literature.[4] Apart from ours, only two studies in the past have reported a positive family history in the ectopic cilia. An autosomal dominant inheritance has been hypothesized by them.[6],[12]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Chen TS, Mathes EF, Gilliam AE. “Ectopic eyelashes” (ectopic cilia) in a 2-year-old girl: Brief report and discussion of possible embryologic origin. Pediatr Dermatol 2007;24:433-5.  |
| 2. | Helper LC, Magrane WG. Ectopic cilia of the canine eyelid. J Small Anim Pract 1970;11:185-9. |
| 3. | Wiegmann E. Eine Zilie an einem ungewöhnlichen Platz, im Knorpel des Oberlides. Klin Monatsbl Augenheilkd 1936;96:230-1. |
| 4. | Kauser H, Kapoor M. A 28-year-old male with anterior ectopic cilia and hypermetropic anisometropic amblyopia. Sudanese J Ophthalmol 2018;10:68-70. [Full text] |
| 5. | Helper LC, Magrane WG. Ectopic cilia of the canine eyelid. J Small Anim Pract 1970;11:185-9. |
| 6. | Baghestani S, Banihashemi SA. Ectopic cilia in a 14-year-old boy. Pediatr Dermatol 2011;28:55-6. |
| 7. | Jakobiec FA, Yoon MK. Histopathologic proof for the origin of ectopic cilia of the eyelid skin. Graefes Arch Clin Exp Ophthalmol 2013;251:985-8. |
| 8. | Bader A. Congenital aplasia of the Meibomian glands of the lower eyelid. Albrecht Von Graefes Arch Ophthalmol 1950;150:411-3. |
| 9. | Möhrenschlager M, Köhler LD, Ring J. Ectopic cilia in a Caucasian girl with atopic eczema. Acta Derm Venereol 1998;78:146-7. |
| 10. | Edmunds MR, Kipioti A, Colloby PS, Reuser TT. A case of ectopic cilia in nail-patella syndrome. Int Ophthalmol 2012;32:289-92. |
| 11. | da Fonseca FL, Yamanaka PK, Lima PP, Matayoshi S. A 6-year-old girl with ectopic cilia and hypochromic nevus. Clin Ophthalmol 2014;8:1259-61. |
| 12. | Goyal T, Varshney A, Bakshi SK. Ectopia cilia with pedigree analysis: Second case report in the world. Indian J Hum Genet 2014;20:185-6. [ PUBMED] [Full text] |
| 13. | Wang Y, Su F, Li Y, Xiao L. Orbital dermoid cyst with sinus tract mimicking ectopic cilia. J AAPOS 2010;14:532-3. |
[Figure 1], [Figure 2], [Figure 3]
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