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Pruritic Trichostasis Spinulosa: A Rare Variant.

Vishal Gaurav¹, Mehul Tyagi¹, Chander Grover²

¹Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.

Indian Dermatology Online Journal

|June 7, 2024

Summary

Trichostasis spinulosa causes hair follicle plugs, often on the face. A rare case presented with itchy, comedo-like lesions on the breast, diagnosed via dermoscopy.

Keywords:

Dermoscopy extraction dermoscopy microscopy pruritic trichostasis spinulosa trichostasis spinulosa

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Area of Science:

Dermatology
Dermatopathology

Background:

Trichostasis spinulosa is a follicular disorder characterized by retained vellus telogen club hairs, typically presenting as asymptomatic comedo-like lesions on the face.
Facial involvement is common, while truncal or breast presentations are rare and can cause significant patient discomfort and morbidity.

Observation:

A 53-year-old female presented with a 2-year history of multiple itchy, bluish-black, comedo-like follicular papules and pustules on her breast and lower abdomen.
Dermoscopic examination revealed keratotic plugs with hair tufts.
Extraction dermoscopy identified a keratin-filled cystic structure containing multiple vellus telogen club hairs.

Findings:

Histopathological analysis confirmed a cyst lined by squamous epithelium, filled with keratinous debris and a vellus hair shaft.
The findings are consistent with Trichostasis spinulosa, despite the unusual location and symptomatic presentation.

Implications:

This case highlights the rare presentation of Trichostasis spinulosa on the trunk and breast, emphasizing its potential for pruritus and associated morbidity.
Dermoscopy, particularly extraction dermoscopy, offers a non-invasive diagnostic method for Trichostasis spinulosa, potentially avoiding the need for a skin biopsy.