Treatment of trichostasis spinulosa with a 755-nm long-pulsed alexandrite laser

Pruritic Trichostasis Spinulosa: A Rare Variant

Trichostasis spinulosa is a disorder of hair follicles characterized by the retention of vellus telogen club hair, leading to the formation of comedo-like lesions. It usually presents over the face and is frequently asymptomatic. We report a 53-year-old female who presented with multiple itchy, discrete, bluish-black, 2-3 mm comedo-like follicular papules and pustules on her breast and lower abdomen for the past 2 years. In-vivo dermoscopy showed keratotic plugs with a tuft of hair. Extraction dermoscopy yielded a cystic structure filled with keratin and multiple vellus telogen club hairs. Histology showed a cyst lined by squamous epithelium containing abundant laminated keratinous debris and a vellus hair shaft. Truncal or breast involvement, as seen in the present case, is relatively rare, and can be pruritic, causing significant morbidity due to itching and secondary bacterial infections. Dermoscopy, especially ex-vivo extraction dermoscopy, can show diagnostic features and obviate the need for abiopsy.

Trichostasis Spinulosa: A Case Report with an Unusual Presentation

Trichostasis spinulosa (TS) is a follicular disorder characterized by the retention of multiple vellus hairs in a hyperkeratotic dilated hair follicle. TS is considered as a common disorder; however, it is often underdiagnosed due to its asymptomatic nature. Although the condition frequently affects the face or extremities, the widespread distribution of TS over the entire body has been once reported in a patient with chronic renal failure. To emphasize the infrequent presentation of TS, we herein report a 57-year-old male with an unusual location of TS.

Efficacy of 800 nm Diode Laser to Treat Trichostasis Spinulosa in Asian Patients

Context:

Trichostasis spinulosa (TS) is a common but underdiagnosed follicular disorder involving retention of successive telogen hair in the hair follicle. Laser hair removal is a newer treatment modality for TS with promising results.

Aims:

This study aims to evaluate the efficacy of 800 nm diode laser to treat TS in Asian patients.

Subjects and Methods:

We treated 50 Indian subjects (Fitzpatrick skin phototype IV–V) with untreated trichostasis spinulosa on the nose with 800 nm diode laser at fluence ranging from 22 to 30 J/cm² and pulse width of 30 ms. The patients were given two sittings at 8 week intervals. The evaluation was done by blinded assessment of photographs by independent dermatologists.

Results:

Totally 45 (90%) patients had complete clearance of the lesions at the end of treatment. Five (10%) subjects needed one-third sitting for complete clearance. 45 patients had complete resolution and no recurrence even at 2 years follow-up visit. 5 patients had partial recurrence after 8–9 months and needed an extra laser session.

Conclusions:

Laser hair reduction in patients with TS targets and removes the hair follicles which are responsible for the plugged appearance. Due to permanent ablation of the hair bulb and bulge, the recurrence which is often seen with other modalities of treatment for TS is not observed here.

Trichostasis spinulosa confirmed by standard skin surface biopsy

Trichostasis spinulosa (TS) is a common but rarely diagnosed disease. For diagnosis, it's sufficient to see a bundle of vellus hair located in a keratinous sheath microscopically. In order to obtain these vellus hair settled in comedone-like openings, Standard skin surface biopsy (SSSB), a non-invasive method was chosen. It's aimed to remind the differential diagnosis of TS in treatment-resistant open comedone-like lesions and discuss the SSSB method in diagnosis. A 25-year-old female patient was admitted with a complaint of the black spots located on bilateral cheeks and nose for 12 years. In SSSB, multiple vellus hair bundles in funnel-shaped structures were observed under the microscope, and a diagnosis of ‘TS’ was made. After six weeks of treatment with tretinoin 0.025% and 4% erythromycin jel topically, the appearance of black macules was significantly reduced. Treatment had to be terminated due to her pregnancy, and the lesions recurred within 1 month. It's believed that TS should be considered in the differential diagnosis of treatment-resistant open comedone-like lesions, and SSSB might be an inexpensive and effective alternative method for the diagnosis of TS.

Treatment of trichostasis spinulosa with 0.5-millisecond pulsed 755-nm alexandrite laser

Trichostasis spinulosa (TS) is a follicular disorder in which multiple hairs in a keratinous sheath project above the skin surface. Current treatments provide temporary relief and side effects are common. We report the successful treatment of TS in 20 patients using a short-pulsed 755-nm alexandrite laser. The 20 patients (skin types II-V) presented with TS lesions on the tip of their nose. All patients received a single treatment (one to three passes) with the laser with cold air cooling but without anaesthesia or analgesia. Treatment parameters were as follows: pulse duration 0.5 ms, fluence 15-17 J/cm(2), and spot size 5 mm. The entire procedure required less than 5 min to perform. The patients were followed up for 3 months for any adverse effects or recurrence. In all patients the lesions disappeared immediately after treatment with minimal or no pain. Erythema was minimal and lasted 5-20 min in all patients. Patients were very satisfied. The treated areas were still clear 4 to 5 weeks later, and a second treatment was not considered necessary. There were adverse effects other than the erythema and there was no recurrence within the follow-up period of 3 months. A single treatment with a short-pulsed 755-nm alexandrite laser appears to be a rapid, minimally painful, and effective treatment for TS in patients of skin types II to V.