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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 23 | 11 | 34 |
| 2024 Octubre | 155 | 43 | 198 |
| 2024 Septiembre | 201 | 46 | 247 |
| 2024 Agosto | 266 | 91 | 357 |
| 2024 Julio | 228 | 74 | 302 |
| 2024 Junio | 240 | 90 | 330 |
| 2024 Mayo | 193 | 116 | 309 |
| 2024 Abril | 172 | 115 | 287 |
| 2024 Marzo | 231 | 53 | 284 |
| 2024 Febrero | 209 | 57 | 266 |
| 2024 Enero | 223 | 62 | 285 |
| 2023 Diciembre | 266 | 32 | 298 |
| 2023 Noviembre | 189 | 57 | 246 |
| 2023 Octubre | 246 | 56 | 302 |
| 2023 Septiembre | 237 | 55 | 292 |
| 2023 Agosto | 171 | 32 | 203 |
| 2023 Julio | 159 | 58 | 217 |
| 2023 Junio | 250 | 42 | 292 |
| 2023 Mayo | 269 | 79 | 348 |
| 2023 Abril | 244 | 41 | 285 |
| 2023 Marzo | 152 | 52 | 204 |
| 2023 Febrero | 130 | 39 | 169 |
| 2023 Enero | 134 | 43 | 177 |
| 2022 Diciembre | 116 | 50 | 166 |
| 2022 Noviembre | 55 | 39 | 94 |
| 2022 Octubre | 85 | 36 | 121 |
| 2022 Septiembre | 109 | 61 | 170 |
| 2022 Agosto | 57 | 49 | 106 |
| 2022 Julio | 51 | 58 | 109 |
| 2022 Junio | 61 | 35 | 96 |
| 2022 Mayo | 176 | 50 | 226 |
| 2022 Abril | 159 | 52 | 211 |
| 2022 Marzo | 215 | 89 | 304 |
| 2022 Febrero | 168 | 46 | 214 |
| 2022 Enero | 161 | 43 | 204 |
| 2021 Diciembre | 117 | 32 | 149 |
| 2021 Noviembre | 121 | 49 | 170 |
| 2021 Octubre | 116 | 59 | 175 |
| 2021 Septiembre | 104 | 46 | 150 |
| 2021 Agosto | 142 | 42 | 184 |
| 2021 Julio | 126 | 25 | 151 |
| 2021 Junio | 110 | 31 | 141 |
| 2021 Mayo | 134 | 39 | 173 |
| 2021 Abril | 206 | 80 | 286 |
| 2021 Marzo | 206 | 33 | 239 |
| 2021 Febrero | 117 | 29 | 146 |
| 2021 Enero | 81 | 19 | 100 |
| 2020 Diciembre | 84 | 14 | 98 |
| 2020 Noviembre | 69 | 22 | 91 |
| 2020 Octubre | 57 | 13 | 70 |
| 2020 Septiembre | 32 | 16 | 48 |
| 2020 Agosto | 55 | 18 | 73 |
| 2020 Julio | 34 | 16 | 50 |
| 2020 Junio | 46 | 30 | 76 |
| 2020 Mayo | 33 | 25 | 58 |
| 2020 Abril | 49 | 14 | 63 |
| 2020 Marzo | 26 | 15 | 41 |
| 2020 Febrero | 4 | 0 | 4 |
| 2020 Enero | 2 | 0 | 2 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 4 | 0 | 4 |
| 2019 Mayo | 4 | 0 | 4 |
| 2019 Abril | 4 | 0 | 4 |
| 2019 Marzo | 2 | 0 | 2 |
| 2019 Febrero | 1 | 0 | 1 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 6 | 0 | 6 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 7 | 0 | 7 |
| 2018 Marzo | 1 | 0 | 1 |
| 2018 Febrero | 64 | 4 | 68 |
| 2018 Enero | 85 | 7 | 92 |
| 2017 Diciembre | 86 | 10 | 96 |
| 2017 Noviembre | 53 | 14 | 67 |
| 2017 Octubre | 112 | 40 | 152 |
| 2017 Septiembre | 7 | 8 | 15 |
| 2017 Agosto | 5 | 9 | 14 |
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