Trichostasis Spinulosa Research Articles

Exploring the Link: Trichostasis Spinulosa and Its Association with Early Phymatous Rosacea

Introduction: Rosacea is a chronic inflammatory skin condition with several clinical subtypes, including phymatous rosacea, which is distinguished by thickened skin, enlarged pores, and irregular surface nodularities, primarily affecting the nose. This manuscript aims to explore the underrecognized connection between early to moderate phymatous rosacea and trichostasis spinulosa (TS), a follicular disorder characterized by the retention of multiple telogen hairs. Methods: A total of consecutive 13 patients with initial phymatous changes and black dilated openings were enrolled. Detailed dermatological assessments, including dermoscopy, were conducted to identify and confirm trichostasis spinulosa. Dermoscopy of the black openings confirmed the presence of hair tufts emerging from dilated follicular openings and plugs. Patients underwent minor procedures using a comedo extractor to remove the hair bundles. Results: All extracted follicular units showed typical characteristics of trichostasis spinulosa, including bundles of telogen hairs surrounded by a sebokeratinous plug. Conclusion: We postulate that the fibrotic processes characteristic of phymatous rosacea may promote the development of TS. Recognizing TS as an early indicator of phymatous rosacea could help prevent disease progression.

Vellus hair follicle diseases

Abstract Human hair follicles are composed of vellus hair follicles (vHFs), sebaceous hair follicles, and terminal hair follicles (tHFs), which share histoanatomy, but differ in biophysiology, therefore are distinctive in clinical morbidities. vHFs are much less studied, and many issues remain to be clarified, such as the expression and regulation of androgen receptors, hair follicle stem cells, immune privilege, and microbiome. Hirsutism is an example of an endocrine disorder with the pathogenesis incompletely understood, especially in idiopathic hirsutism. Interactions between androgens and other hormones deserve special attention. Treatment is unstandardized, whereas combination of antiandrogens and laser shows promise. Keratosis pilaris, a keratinization disorder, lacks clarity in etiopathogenesis, impacting esthetics and therapeutic efficacy. Among the inflammatory disorders, perioral/periorbital dermatitis arises from vHFs irritation, categorized into papular, eczematous, and granulomatous forms. This necessitates varied differential diagnoses and therapeutic approaches. Follicular eczema, a variant of atopic dermatitis in children, is also associated with xerotic dermatitis and allergic contact dermatitis in adults. Bacterial infections rarely target vHFs, in contrast to tHFs. Trichodysplasia spinulosa (TdS) links to TdS-associated polyomavirus infection localized to the inner root sheath cells of vHFs, underdiagnosed in immunocompromised patients. The varying manifestation and pathogenic significance of Malassezia furfur in Malassezia (pityrosporum) folliculitis, pityriasis versicolor, and seborrheic dermatitis remain debated. Proliferative/neoplastic entities of vHFs include vellus hair cyst, pilomatrixoma, trichoepithelioma, and trichostasis spinulosa. Follicular spiny hyperkeratosis, lichen spinulosus, and lichen scrofulosorum are reactive conditions of vHFs. Recognizing vHF-associated diseases helps us to better understand the human hair follicles and to enhance daily dermatological practices.

Dermatoscopy of the Pruritic Variant of Trichostasis Spinulosa: A Noninvasive Diagnostic Method

Trichostasis spinulosa is a hair follicular disorder hyperkeratotic dilated hair follicles with retention of multiple vellus hairs. It is a common disorder often unrecognized by patients. Dermatoscopy helps in diagnosis and deciding the treatment of this disorder avoiding unnecessary skin biopsy. Here, we report a case of a pruritic variant of trichostasis spinulosa with characteristic signs of hair retention in dermatoscopy.

Dermoscopic Features of Lichenoid Pseudovesicular Papular Eruption of the Nose (LiPEN): A Rare Entity.

Dermoscopic Features of Lichenoid Pseudovesicular Papular Eruption of the Nose (LiPEN): A Rare Entity.

“Extraction Dermoscopy”: Expanding the Utility of Epiluminescence Microscopy

Introduction: Many dermatological conditions require extraction of material from the lesion followed by visualization under a microscope. However, visualization of the extracted material can be done using a dermoscope instead. We propose “extraction dermoscopy” as an addition to the already existing treasury that dermoscopy holds. Methods: After approval from the institutional ethics committee, a cross-sectional study was carried out in a tertiary care hospital. Polarized and non-polarized versions of in vivo dermoscopy, as well as extraction dermoscopy, were performed on a total of 77 lesions, including 5 eruptive vellus hair cysts, 2 cilia incarnata externum, 10 trichostasis spinulosa, 20 keratosis pilaris, 20 molluscum contagiosum, and 20 lesions of milia. Heine Delta 20T and Dino-Lite Premier AM4113T were employed for dermoscopic examination. Results: A total of 77 lesions were selected, including 5 eruptive vellus hair cysts, 2 cilia incarnata externum, 10 trichostasis spinulosa, 20 keratosis pilaris, 20 molluscum contagiosum, and 20 lesions of milia. Extraction dermoscopy of the eruptive vellus cysts revealed skin color to brownish colored cysts with a bunch of pigmented hair. Similarly, findings of all other lesions were described and recorded post-extraction. Conclusion: Extraction dermoscopy helps confirm the diagnosis without visualization under a microscope. Its application in recent times makes the explanation of the nature of many disorders to patients easier, and demonstration of extracted lesions may further improve doctor-patient communication.

Trichostasis Spinulosa as Manifestation of Cutaneous Graft versus Host Disease.

Trichostasis Spinulosa as Manifestation of Cutaneous Graft versus Host Disease.

Dermoscopic Findings and Their Therapeutic Implications in Trichostasis Spinulosa: A Retrospective Study of 306 Patients

Background: Data about the contribution and the implications of dermoscopy in trichostasis spinulosa (TS) are lacking in the literature. Objective: To describe dermoscopic features of TS in a large sample of patients and to correlate dermoscopy with clinical characteristics of the patients and therapeutic responses to medical treatments. Methods: A descriptive study was conducted (from October 2015 to June 2016) at the Department of Dermatology of Fez in Morocco. Dermoscopic signs were divided into signs of hair retention (SHR) and follicular keratosis (FK). Results: SHR was severe in 8.8% and minimal in 40.5% of all cases. Vellus hairs were observed in 81.6% of all cases and hair tufts were described in 48.7%. Dermoscopic blackhead-like structures (DBH) were found in 53.9% of all cases. FK was observed as orange-yellowish keratotic plugs in 92.7% of all cases. Therapeutic demand was significantly related to female gender (p = 0.002) and recurrences after medical treatment (p = 0.004). Complete improvement after medical treatment was only described in patients with DBH and minimal SHR (p = 0.001). Conclusion: Dermoscopy not only increases the accuracy of the clinical diagnosis in TS, but a new description of dermoscopic classification has also been proposed leading to therapeutic implications.

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.

Nevoid Trichostasis Spinulosa: Dermoscopic Point of View

ABSTRACTTrichostasis spinulosa (TS) is a common yet underdignosed condition affecting hair follicles. Diagnosis is based on the clinical features, hair mount, and dermoscopy. Here, the authors describe a case of TS in a nevoid distribution wherein dermoscopy aided the diagnosis.How to cite this articleAnkad BS, Shah S, Mallapur AA. Nevoid Trichostasis Spinulosa: Dermoscopic Point of View. Int J Dermoscop 2017;1(2):65-66.

Incidence of trichostasis spinulosa at a single institution in Yemen

Trichostasis spinulosa (TS) is a common, underdiagnosed cosmetic skin condition. The main objectives of this study were to determine the occurrence of TS relative to age and gender, to analyze its cutaneous distribution, and to investigate any possible familial basis for this condition, its impact on patients, and the types and efficacy of previous treatments. All patients presenting to the outpatient dermatology clinic at the study institution and their relatives were examined for the presence of TS and were questioned about family history and previous treatment. Photographs and biopsies of suspected cases of TS were obtained. Of 2400 patients seen between August and December 2013, 286 patients were diagnosed with TS (135 males, 151 females; prevalence: 11.9%). Women presented more frequently than men with complaints of TS (6.3 vs. 4.2%), and more women had received prior treatment for TS (10.5 vs. 2.8%). The most commonly affected sites were the face (100%), interscapular area (10.5%), and arms (3.1%). Lesions involved the nasal alae in 96.2%, the nasal tip in 90.9%, the chin in 55.9%, and the cheeks in 52.4% of patients. Only 15.7% of patients had forehead lesions, and only 4.5% had perioral lesions. Among the 38 previously treated patients, 65.8% reported temporary improvement. Trichostasis spinulosa is a common condition that predominantly affects the face in patients of all ages. Additional studies employing larger cohorts from multiple centers will be required to determine the prevalence of TS in the general population.

Trichostasis spinulosa: An overlooked entity.

A 50-year-old female visited our department for the treatment of rosacea. Dermatological examination revealed erythematous papules and plaques over both cheeks. Black macules were found on the nose [Figure 1], but the patient was not worried about the lesions. Dermoscopic (×25 and ×60) examination revealed that the black macules were vellus hairs [Figure 2]. The hairs were plucked and observed under dermascope which showed multiple vellus hairs bundled in a funnel-like structure [Figure 3]. The above findings were suggestive of trichostasis spinulosa (TS). Patient refused treatment for the lesions.Figure 1: Multiple black macules on noseFigure 2: Dermoscopic (×25 and ×60) examination revealing vellus hairsFigure 3: Plucked hairs observed under dermascope (×25 and ×60) showing multiple vellus hairs bundled in a funnel-like structureTS is a very common but unrecognized disorder of pilosebaceous unit. It is a midfacial disease that occurs in younger age in female patients with Fitzpatrick skin type III or higher. It may also occur in light-skinned older people with excessive ultraviolet-exposure.[12] TS was first recognized by the German dermatologist Felix Franke in 1901, who named it “Pinselhaar” (paintbrush hair). In 1913, Noble first coined the term “trichostasis spinulosa.”[1] The exact etiology of this disease is not known. Abnormal angulation of the hair follicle may lead to the entrapment of vellus hairs. Follicular hyperkeratosis of a dilated vellus hair follicle leading to retention of successive telogen hairs is another explanation. Number of retained hairs may range from 5 to 60.[12] TS occurs sporadically, but many trigger factors have been identified. These include topical minoxidal, topical steroids, chronic renal failure, dust, oils, ultraviolet light, heat, and irritants.[12] Two variants of TS have been described: Nonpruritic type, which is classical and often seen in the elderly as asymptomatic blackhead-like lesions located on the face. The other variant is the pruritic type, characterized by multiple pinhead-sized papules on the trunk and upper extremities in young adults.[3] The present case is a classical type with the involvement of nose. Various modalities of treatment are tried with variable results which includes emollients, hydroactive adhesive tapes, local keratolytics, local and oral retinoids.[1] Repeated peeling with capryloyl salicylic acid has given good result.[2] Herein we present a classical case of TS to increase the awareness of this common disease.

Favre-Racouchot syndrome.

Favre-Racouchot syndrome.

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.

Trichostasis Spinulosa – Successful Treatment by Repeated Peeling with Capryloyl Salicylic Acid

Trichostasis spinulosa is an uncommon midfacial disease with negative impact on self esteem and appearance. Many available treatments provide only short time improvement. We report a 36-year-old female treated with a series of four capryloyl salicylic acid peelings with significant improvement for at least 24 months.

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 0.5ms, fluence 15-17J/cm(2), and spot size 5mm. The entire procedure required less than 5min to perform. The patients were followed up for 3months 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 5-20min in all patients. Patients were very satisfied. The treated areas were still clear 4 to 5weeks 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 3months. 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.

Acute Encephalomyelitis Syndromes Associated with H1N1 Influenza Vaccinations; Erythema Multiforme Secondary to H1N1 Vaccine; Cytolytic Hepatitis Possibly Related to Oral Contraceptives; Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Associated with Lamotrigine: First Report; Behavioral Disinhibition with Baclofen; Minoxidil-Induced Trichostasis Spinulosa of Terminal Hair; Delayed-Onset Mirtazapine-Related Leukopenia

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers.

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

Trichostasis spinulosa (TS) is a common disorder of hair follicle, characterized by spinous plugs. Topical treatments offer temporary relief but permanent removal of the abnormal follicles using hair removal lasers may result in a definite cure. To evaluate the safety and efficacy of 755-nm alexandrite laser for the treatment of TS lesions. Two consecutive 755-nm alexandrite laser treatments were performed one month apart. The clinical response and adverse effects were assessed four weeks after the first and second treatments and 20 weeks after the second treatment. Thirty one patients with skin phototypes II to IV completed the study. At the last follow up visit, a decrease in dark-plug density of greater than 50% was noted in 16 patients (51.3%), while only three patients (9.7%) had an improvement of greater than 75%. Ten of the 21 patients (47.6%) with skin type III and six of the seven patients (85.7%) with skin type IV achieved at least 50% improvement in lesions at the last follow up visit (P = 0.1). The 755-nm alexandrite laser can safely and effectively reduce TS lesions lasting for a relatively long time in patients with skin types III-IV.

Familiar occurrence of multiple primary epidermoid cysts and trichostasis spinulosa: a novel skin phenotype associated with inherited sensorineural deafness

Familiar occurrence of multiple primary epidermoid cysts and trichostasis spinulosa: a novel skin phenotype associated with inherited sensorineural deafness

Dermoscopy of Trichostasis Spinulosa

T RICHOSTASIS SPINULOSA (TS) IS A RELAtively common but underdiagnosed disorder of hair follicles that retain successive telogen hairs. It has been described within skin lesions (secondary TS) or as an isolated finding (primary TS). Dermoscopy may help identify the characteristic hair tuft. We report 2 cases of TS. The first case involved a 23-year-old woman who presented with a long-standing history of a light-brown papule on the lower part of her back. There was a black punctum in the upper central area of the lesion (Figure 1). Dermoscopy showed a sparse pigment network, multiple commalike blood vessels that are typical of intradermal melanocytic nevi, a few peripheral vellous hairs, and a small hair tuft emerging from the central punctum (Figure 2). Histologic examination confirmed the presence of an intradermal melanocytic nevus along with dilated folliculosebaceous units containing several cross-sectioned hair shafts (Figure 3). The second case involved a 30-yearold man who presented with a micropapular eruption on both flanks. Dermoscopy showed multiple vellous hairs erupting through the follicles (Figure 4). Hair tufts are the result of folliculosebaceous hamartomas with multiple units around a central pore (trichofolliculomas) or retained hair shafts within follicles with infundibular keratosis (TS). Trichostasis spinulosa may appear as an isolated finding or in association with expansile nondestructive lesions that narrow hair infundibulae, such as melanocytic nevi, seborrheic keratoses, syringomas, or nodular basal cell carcinomas. Dermoscopy is helpful in diagnosing TS.

Trichostasis spinulosa: possible association with prolonged topical application of clobetasol propionate 0.05% cream

A 20-year-old woman of south Asian descent was concerned about her dark complexion, predominantly affecting the exposed areas of her body, including the face, neck, upper chest, and extremities. She tried multiple over-the-counter products, including topical hydroquinone, kojic acid, and various herbal formulations, without success. Three years previous to her presentation, she was given clobetasol propionate 0.05% cream by a friend, which she applied to the face, neck, upper chest, and arms. After 6 weeks of twice-daily application, she noted marked improvement of her complexion; thus, she continued to use clobetasol propionate cream thereafter. She applied approximately 10 g of cream daily. One year previous to her presentation, she noticed an asymptomatic eruption of tiny dark-brown papules and “open pores” on the face, neck, upper chest, and arms. She thought her dark complexion was returning, and continued to use topical corticosteroid for another year without improvement. She was advised to see a dermatologist. Physical examination revealed multiple, dark-brown, follicular papules involving the face, neck, upper chest, arms, and antecubital areas (1-3). There was a rough sensation on palpation. On examination with a hand lens, tufts of hairs were visible projecting through each of the tiny papules. Manual attempts to express material from the lesions were unsuccessful. A few of the horny plugs were removed with a sterile needle. Multiple vellus hairs were seen embedded in keratinous material on light microscopy of the extracted plugs (Fig. 4). The patient refused a skin biopsy. Figure 1Open in figure viewerPowerPoint Dark-brown follicular papules on the face Figure 2Open in figure viewerPowerPoint Dark-brown follicular papules on the chest Figure 3Open in figure viewerPowerPoint Dark-brown follicular papules on the arm and antecubital area Figure 4Open in figure viewerPowerPoint Bundle of vellus hairs surrounded by a keratinous sheath (magnification, ×10) In addition to the dark follicular papules, multiple open comedones were present on the malar areas, and hypertrichosis was evident on the chin and lower cheeks. Telangiectasias were also visible over the malar areas and the arms. Her past medical history, the rest of the physical examination, and routine blood and urinalyses, including serum free testosterone, blood urea nitrogen, and serum creatinine levels, were unremarkable. On the basis of the clinical and light microscopic findings, a diagnosis of trichostasis spinulosa (TS) was made. She was advised to discontinue the use of corticosteroid cream. Her treatment consisted of daily tretinoin 0.05% cream over the affected areas at bedtime. A marked improvement of the TS lesions and comedonal acne was noted at the 3-month follow-up visit (5-7). There was no improvement of the hypertrichosis and telangiectasias. Figure 5Open in figure viewerPowerPoint Marked improvement of comedonal acne and trichostasis spinulosa lesions on the face after topical therapy with tretinoin 0.05% cream at the 3-month follow-up Figure 6Open in figure viewerPowerPoint Marked improvement of trichostasis spinulosa lesions on the chest after topical therapy with tretinoin 0.05% cream at the 3-month follow-up Figure 7Open in figure viewerPowerPoint Marked improvement of trichostasis spinulosa lesions on the arm and the antecubital area after topical therapy with tretinoin 0.05% cream at the 3-month follow-up. Postinflammatory hyperpigmentation is evident