Trichostasis Spinulosa Confirmed by Standard Skin Surface Biopsy

Abstract

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.

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

“…The disease usually follows a chronic refractory course and tends to reappear after discontinuation of treatment [2, 3]. The spines of impacted hairs can be removed by tweezing, by pressure expression [7], or keratolytics [2].…”

“…Skin biopsy of the contents of black papules shows findings of dilated hair follicle containing multiple VH with mild inflammation. Also, TS should be considered in the differential diagnosis when treatment-resistant comedo-like lesions are seen [3]. Recently, dermoscopy has been reported to be the most helpful, easy, and noninvasive tool to diagnose TS [1, 4].…”

Trichostasis spinulosa at an unusual site

“…Lasers such as 800 nm pulse-diode and 755 nm alexandrite lasers have been reported to be effective in the removal of abnormal hair follicles. [ 9 ]…”

Trichostasis spinulosa: An entity with cosmetic concern

“…ese retained hairs are usually more pigmented and thinner at the distal end, the proximal intrafollicular portion is lighter in color and bulbous indicating that they are in the telogen phase of the hair cycle. [6,35]…”