Case and Research Letter
Filiform Follicular Hyperkeratosis on the Face
Hiperqueratosis folicular filiforme en la cara
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During a routine follow-up visit, the patient reported the appearance of asymptomatic plaques on both cheeks that were mildly erythematous and rough to the touch.</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 facial skin with a xerotic appearance on both cheeks and along the mandibular rami and erythematous plaques with a distinct border (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Dermoscopy revealed hyperkeratosis and dilation of hair follicles (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). On palpation, the skin had a rough, sandpaper-like texture. The skin examination was otherwise unremarkable.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Additional Tests</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 2-mm punch biopsy was taken from the left preauricular region. Histologic examination revealed the presence of 2 dilated follicular infundibula, with foci of compact hyperkeratosis, associated in both cases with the presence of a mite (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). A mild perivascular lymphocytic inflammatory infiltrate was observed in the underlying dermis.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The complete blood count and biochemistry profile showed no abnormalities.</p><p id="par0025" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Spinulosis of the face.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course</span><p id="par0035" class="elsevierStylePara elsevierViewall">Following histologic confirmation of spinulosis of the face associated with <span class="elsevierStyleItalic">Demodex folliculorum</span>, treatment was initiated with 0.5% ivermectin in carbohydrate-based cream once daily for 2 months. Clinical improvement was evident after 1 month of treatment and all signs had resolved by the end of treatment. No similar lesions have appeared during 6 months of follow-up.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Spinulosis of the face is characterized by the presence of asymptomatic, hyperkeratotic, filiform spicules with a follicular distribution, located predominantly on the facial skin (cheeks, forehead, and chin). Although the association of this entity with <span class="elsevierStyleItalic">D folliculorum</span> was initially controversial, today the causal relationship is accepted.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">D folliculorum</span> is a mite that is occasionally found in human skin in association with the pilosebaceous unit. This colonization is generally asymptomatic, but in predisposed individuals the presence of <span class="elsevierStyleItalic">D folliculorum</span> has been associated with various dermatoses, including rosacea, perioral dermatitis, and madarosis. The presence of 5 or more mites per square centimeter of skin or the presence of the mite in the dermis has been proposed as a pathogenic criterion.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In the case of spinulosis of the face associated with <span class="elsevierStyleItalic">D folliculorum</span>, case series in patients with other diseases—particularly multiple myeloma and polycythemia vera—have been reported. Other associations with spinulosis of the face caused by <span class="elsevierStyleItalic">D folliculorum</span> include chronic renal failure, inflammatory bowel disease, and monoclonal gammopathy.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,4</span></a> Differential diagnosis should include eczema, seborrheic dermatitis, pityriasis folliculorum (which is also caused by <span class="elsevierStyleItalic">D folliculorum</span> but is associated with diffuse scaling, pruritus, and erythema, and in many cases with poor facial hygiene),<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> and trichodysplasia spinulosa, a polyomavirus infection that occurs in immunocompromised patients and is characterized by hyperkeratotic spicules, especially on the face (nose, eyebrows, etc.), and causes the facial deformity leonine facies.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Diagnosis is based on clinical suspicion. Thin spicules confined to the dilated follicular orifices of the face, making the skin of the affected areas rough to the touch, are highly characteristic. Histologic examination confirms the presence of the mite and hyperkeratotic material forming spicules in the follicular orifices.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Like other skin diseases caused by <span class="elsevierStyleItalic">Demodex</span> mites, spinulosis of the face is treated with various specific antiparasitic agents. Topical treatment is sufficient in most cases. Drugs used include 0.75% metronidazole, 5% permethrin, and 0.5% ivermectin, with the latter achieving good response, as in our patient.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> In resistant cases, oral therapy with ivermectin or retinoids, among other drugs, can be used.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,3</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Additional Tests" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ruiz-Rivero J, Domíngez MC, Blanco VP, Suárez-Fernández R. Hiperqueratosis folicular filiforme en la cara. Actas Dermosifiliogr. 2017;108:773–774.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 968 "Ancho" => 1500 "Tamanyo" => 271173 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 968 "Ancho" => 1583 "Tamanyo" => 138896 ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1188 "Ancho" => 1583 "Tamanyo" => 411068 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×40.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Espinulosis como manifestación de demodicidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 22 | 11 | 33 |
| 2024 October | 155 | 43 | 198 |
| 2024 September | 201 | 46 | 247 |
| 2024 August | 266 | 91 | 357 |
| 2024 July | 228 | 74 | 302 |
| 2024 June | 240 | 90 | 330 |
| 2024 May | 193 | 116 | 309 |
| 2024 April | 172 | 115 | 287 |
| 2024 March | 231 | 53 | 284 |
| 2024 February | 209 | 57 | 266 |
| 2024 January | 223 | 62 | 285 |
| 2023 December | 266 | 32 | 298 |
| 2023 November | 189 | 57 | 246 |
| 2023 October | 246 | 56 | 302 |
| 2023 September | 237 | 55 | 292 |
| 2023 August | 171 | 32 | 203 |
| 2023 July | 159 | 58 | 217 |
| 2023 June | 250 | 42 | 292 |
| 2023 May | 269 | 79 | 348 |
| 2023 April | 244 | 41 | 285 |
| 2023 March | 152 | 52 | 204 |
| 2023 February | 130 | 39 | 169 |
| 2023 January | 134 | 43 | 177 |
| 2022 December | 116 | 50 | 166 |
| 2022 November | 55 | 39 | 94 |
| 2022 October | 85 | 36 | 121 |
| 2022 September | 109 | 61 | 170 |
| 2022 August | 57 | 49 | 106 |
| 2022 July | 51 | 58 | 109 |
| 2022 June | 61 | 35 | 96 |
| 2022 May | 176 | 50 | 226 |
| 2022 April | 159 | 52 | 211 |
| 2022 March | 215 | 89 | 304 |
| 2022 February | 168 | 46 | 214 |
| 2022 January | 161 | 43 | 204 |
| 2021 December | 117 | 32 | 149 |
| 2021 November | 121 | 49 | 170 |
| 2021 October | 116 | 59 | 175 |
| 2021 September | 104 | 46 | 150 |
| 2021 August | 142 | 42 | 184 |
| 2021 July | 126 | 25 | 151 |
| 2021 June | 110 | 31 | 141 |
| 2021 May | 134 | 39 | 173 |
| 2021 April | 206 | 80 | 286 |
| 2021 March | 206 | 33 | 239 |
| 2021 February | 117 | 29 | 146 |
| 2021 January | 81 | 19 | 100 |
| 2020 December | 84 | 14 | 98 |
| 2020 November | 69 | 22 | 91 |
| 2020 October | 57 | 13 | 70 |
| 2020 September | 32 | 16 | 48 |
| 2020 August | 55 | 18 | 73 |
| 2020 July | 34 | 16 | 50 |
| 2020 June | 46 | 30 | 76 |
| 2020 May | 33 | 25 | 58 |
| 2020 April | 49 | 14 | 63 |
| 2020 March | 26 | 15 | 41 |
| 2020 February | 4 | 0 | 4 |
| 2020 January | 2 | 0 | 2 |
| 2019 December | 4 | 0 | 4 |
| 2019 November | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 4 | 0 | 4 |
| 2019 April | 4 | 0 | 4 |
| 2019 March | 2 | 0 | 2 |
| 2019 February | 1 | 0 | 1 |
| 2019 January | 3 | 0 | 3 |
| 2018 December | 6 | 0 | 6 |
| 2018 November | 3 | 0 | 3 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 7 | 0 | 7 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 64 | 4 | 68 |
| 2018 January | 85 | 7 | 92 |
| 2017 December | 86 | 10 | 96 |
| 2017 November | 53 | 14 | 67 |
| 2017 October | 112 | 40 | 152 |
| 2017 September | 7 | 8 | 15 |
| 2017 August | 5 | 9 | 14 |
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