Cases for Diagnosis
Vellus Hair Cyst of Several Months’ Duration on the Arm
Quiste velloso en brazo de meses de evolución
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"apellidos" => "Lorido Cortes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Sección de Dermatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sección de Anatomía Patológica, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Quiste velloso en brazo de meses de evolución" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 382 "Ancho" => 1005 "Tamanyo" => 165424 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin–eosin, original magnification ×100 (A), ×20 (B).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 21-year-old white man with no personal history of interest was referred from primary care for an asymptomatic lesion on the right arm that had appeared 10 months earlier.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a lesion of approximately 4<span class="elsevierStyleHsp" style=""></span>mm in diameter, with a nodulocystic appearance and a central tuft of white hairs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Dermoscopy showed a white–pink area with a slightly depressed and scaly center from which a tuft of fine whitish hair emerged. No indications of a melanocytic lesion nor any specific vascular pattern were observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Biopsy after excision showed a dilated central follicle from which numerous small secondary and tertiary follicles arose, with panfollicular differentiation. The central follicle contained keratin and hair shafts. The small follicles were largely mature, and abortive follicles radiated into the surrounding dermis. Sebaceous glands were detected (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What is your diagnosis?</span></p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Trichofolliculoma.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Comment</span><p id="par0030" class="elsevierStylePara elsevierViewall">Trichofolliculoma (TF) is a benign, infrequent hamartoma with follicular differentiation, and is more commonly found in adults. No sexual predilection has been described. It occurs spontaneously, although appearance after trauma has also been reported. It usually presents as a solitary, normal skin-colored papule of variable size, with a central depression from which a tuft of fine white hair emerges. The most common location is the face, followed by the neck and scalp.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> However, the literature includes cases of congenital TF, multiple TF, and extrafacial TF. The clinical differential diagnosis includes entities such as fibrous papule of the nose, fistula of the dorsum of the nose, and trichostasis spinulosa.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Histology is diagnostic and characteristic, revealing cyst-like dilation of the infundibulum, infundibular cornification, and central orthokeratin. Secondary and tertiary hair follicles radiate radially from this central structure. The perilesional stroma is fibrous and lamellar and is characteristically separated by clefts from the stroma of the adjacent healthy dermis. Piloerector muscles are usually absent and sebaceous differentiation is minimal in typical cases.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Secondary follicles containing abundant sebaceous acini are a feature of a variant known as sebaceous TF. Several authors distinguish 3 stages of TF (early, complete or developed, and late) that correspond to the hair follicle cycle. The most striking sebaceous differentiation is observed in late TF. Some authors even argue that so-called folliculosebaceous cystic hamartoma may correspond to longstanding TF. However, according to other authors these are distinct entities.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> No cases of malignant transformation have been described to date, and published cases of TF with perineural infiltration appear to correspond more to microcystic adnexal carcinomas. The main histological differential diagnoses are dilated pore of Winer, fibrous papule of the nose, fibrofolliculoma, and hair follicle nevus.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Descriptions of dermoscopic findings are scarce, and vary depending on the stage of evolution of the lesion. Panasti et al. described a “fireworks” pattern in a TF lesion of 4 months duration. This pattern consists of a central brown area with dark brown radial projections and the absence of a pigmented reticulum. García-García et al. recently described the following dermoscopic characteristics of a TF lesion that had appeared 1 year earlier: a bluish nodule with a central whitish–pink area, bright white structures, punctate vessels, and central scaling.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5,6</span></a> This pattern more closely resembles that observed in our patient, whose lesion also featured a characteristic tuft of fine white hair. In summary, the role of dermoscopy in the diagnosis of adnexal tumors remains to be defined.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Because TF is a benign entity, treatment is not required, except for diagnostic or cosmetic reasons. In contrast to other pilar tumors, no associations with any major disease are described in the literature.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:3 [ "identificador" => "sec0015" "titulo" => "Histopathology" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] ] ] 3 => array:2 [ "identificador" => "sec0025" "titulo" => "Comment" ] 4 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of Interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 802 "Ancho" => 605 "Tamanyo" => 59514 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical appearance of the lesion.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 568 "Ancho" => 755 "Tamanyo" => 34305 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic examination shows a central whitish hair plug surrounded by a white-pink area.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 382 "Ancho" => 1005 "Tamanyo" => 165424 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin–eosin, original magnification ×100 (A), ×20 (B).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trichofolliculomes: revue rétrospective de 8 cas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.-H. 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Bañuls" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.det.2018.05.007" "Revista" => array:6 [ "tituloSerie" => "Dermatol Clin" "fecha" => "2018" "volumen" => "36" "paginaInicial" => "397" "paginaFinal" => "412" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30201149" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011300000004/v1_202205250546/S0001731022001892/v1_202205250546/en/main.assets" "Apartado" => array:4 [ "identificador" => "93538" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Casos para el diagnóstico / Cases for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011300000004/v1_202205250546/S0001731022001892/v1_202205250546/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731022001892?idApp=UINPBA000044" ]
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| 2024 April | 88 | 42 | 130 |
| 2024 March | 99 | 52 | 151 |
| 2024 February | 82 | 44 | 126 |
| 2024 January | 87 | 34 | 121 |
| 2023 December | 107 | 29 | 136 |
| 2023 November | 119 | 34 | 153 |
| 2023 October | 105 | 47 | 152 |
| 2023 September | 114 | 36 | 150 |
| 2023 August | 110 | 23 | 133 |
| 2023 July | 140 | 60 | 200 |
| 2023 June | 95 | 30 | 125 |
| 2023 May | 120 | 29 | 149 |
| 2023 April | 172 | 34 | 206 |
| 2023 March | 178 | 35 | 213 |
| 2023 February | 167 | 27 | 194 |
| 2023 January | 181 | 59 | 240 |
| 2022 December | 118 | 44 | 162 |
| 2022 November | 119 | 43 | 162 |
| 2022 October | 112 | 48 | 160 |
| 2022 September | 136 | 48 | 184 |
| 2022 August | 102 | 55 | 157 |
| 2022 July | 95 | 51 | 146 |
| 2022 June | 102 | 58 | 160 |
| 2022 May | 85 | 46 | 131 |
| 2022 April | 33 | 42 | 75 |
| 2022 March | 39 | 60 | 99 |
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