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

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.

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.

All extracted follicular units showed typical characteristics of trichostasis spinulosa, including bundles of telogen hairs surrounded by a sebokeratinous plug.

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.