Eruptive vellus hair cysts with sebaceous glands

Eruptive vellus hair cysts: report of a new case with immunohistochemical study and literature review

Eruptive vellus hair cysts (EVHC) are rather uncommon lesions, of which 222 cases have been published in the literature. Their etiopathogenesis is poorly known. We report herein a new typical case of EVHC that was studied immunohistochemically. A 15-year-old male presented with a 4-year history of progressively developing small brown-gray papules on the trunk and extremities. Microscopically the lesions consisted of small epidermoid cysts containing vellus hairs. Immunohistochemically, the lesions expressed keratin 1/10, calretinin and p63 but no epithelial membrane antigen, filaggrin or androgen receptors. A review of the relevant literature shows that EVHC may be inherited or acquired and may be associated to other genodermatoses, namely sebocystomatosis. They could be due to hamartomatous follicular growth, to a trouble in infundibular keratinization leading to vellus hair follicle occlusion, or represent an example of acquired hamartoma. Although benign, this condition is difficult to treat.

Eruptive vellus hair cysts: a systematic review

We report the results of the first systematic review of the worldwide literature on eruptive vellus hair cysts (EVHC). It is likely that EVHC are less rare than it may appear from the scarcity of related publications in the literature. EVHC may be present at birth and may appear at any age, although they show a clear trend towards occurring during the first 3 decades of life. A strong clue to the heavy influence of genes on the occurrence of EVHC is provided by the numerous reports of families in whom two or more members were affected. EVHC lesions present clinically in a rather monomorphous fashion, i.e. round, dome-shaped, skin-colored, asymptomatic, soft-tender papules with a smooth surface and grouped or disseminated in a symmetric pattern. EVHC may affect any cutaneous area, even if the upper part of the body and some distribution patterns are particularly frequent and recognizable, i.e. cephalic, upper trunk around the midline, upper limb including axillae, and proximal lower limb. Such a distribution is likely not random and seems to grossly overlap with that of pilosebaceous and apocrine units. Like clinical morphology, the histologic features of EVHC papules are rather monomorphous, indeed, the diagnostic hallmark being the presence of vellus hair shafts within the cystic space. Peculiar subgroups (familial, late-onset, unilesional, and associated with steatocystoma multiplex) are also identified and discussed. In conclusion, EVHC are basically a cosmetic concern to patients but represent a chronic and difficult-to-treat condition. On the basis of our review, future studies are warranted, mainly concerning (i) further nosographic framing involving genetic and tissue analysis, (ii) implementation of non-invasive diagnostic procedures, and (iii) therapeutic trials of interventions shown to achieve some effectiveness.

A Case of Multiple Pilosebaceous Cysts

Multiple pilosebaceous cysts include the entities of steatocystoma multiplex and eruptive vellus hair cysts (EVHCs). Multiple pilosebaceous cysts are proposed to be one entity originating in the pilosebaceous duct, since steatocystoma multiplex and EVHCs are frequently present concomitantly and are caused by a cystic change in the same pilosebaceous duct. Here, we describe a patient with yellowish papules, 3–8 mm in diameter, on the neck and skin-colored or light-brown papules, 1–3 mm in diameter, on the neck, chest and upper abdomen. The smaller cysts were histopathologically diagnosed as EVHCs. The larger cysts had both features of EVHCs and steatocystoma multiplex. Therefore, a diagnosis of these lesions was made as multiple pilosebaceous cysts. Our case supports the proposition that multiple pilosebaceous cysts are a more appropriate diagnosis than the terms of EVHCs and steatocystoma multiplex.

Missense mutations in keratin 17 cause either pachyonychia congenita type 2 or a phenotype resembling steatocystoma multiplex

Pachyonychia congenita (PC) is a group of autosomal dominant ectodermal dysplasias in which the main phenotypic characteristic is hypertrophic nail dystrophy. In the Jackson-Lawler form (PC-2), pachyonychia is accompanied by multiple pilosebaceous cysts, natal teeth, and hair abnormalities. By direct sequencing of genomic PCR products, we report heterozygous K17 missense mutations in the same conserved protein motif in a further five PC-2 families (K17 N92S in one familial and three sporadic cases; K17 Y98D in one familial case) confirming that mutations in this gene are a common cause of PC-2. We also show heterozygous missense mutations in K17 (N92H and R94H) in two families diagnosed as steatocystoma multiplex. Mild nail defects were observed in some but not all of these patients on clinical re-evaluation of these families. All the K17 mutations reported here were shown to co-segregate with the disease in the pedigrees analyzed and were excluded from 100 unaffected, unrelated chromosomes by restriction enzyme analysis of K17 genomic PCR products. We conclude that phenotypic variation is observed with K17 mutations, as is the case with other keratin disorders.

Hybrid cysts showing alternate combination of eruptive vellus hair cyst, steatocystoma multiplex, and epidermoid cyst, and an association among the three conditions

Eruptive vellus hair cyst (EVHC), steatocystoma multiplex (SM), and epidermoid cyst are characterized by formation of multiple cutaneous cysts and have a resemblance in clinical features but have distinctive histologic features. We present herein two patients, who had EVHC, SM, and EVHC with sebaceous gland, and who also had EVHC, SM, and epidermoid cyst with sebaceous gland and vellus hairs. In addition, the interrelation among the three diseases is discussed. We think that EVHC, SM and epidermoid cyst are within the same spectrum of the disease process.

Multiple pilosebaceous cysts

We report two patients initially diagnosed as having steatocystoma multiplex (SM). Other cysts showed characteristics of eruptive vellus hair cyst (EVHC). More than 30 and 14 cysts, respectively, were removed with histological hybrid characteristics of SM and EVHC. This suggests that SM and EVCH are two closely related entities, which represent a naevoid malformation in the area where the sebaceous duct and hair follicle meet.

Pigmented follicular cyst

A pigmented follicular cyst is an infrequent variant of an epithelial cyst which has rarely been reported since it was first described about 10 years ago. The condition consists of a single pigmented lesion which occurs predominantly in adult men, and is usually located on the head and neck region. We report an example of a pigmented follicular cyst, which was located in the axilla.