Cyst in chest - Eruptive vellus hair cysts (EVHCs)

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What are eruptive vellus hair cysts?

Eruptive vellus hair cysts (EVHCs) are multiple papular eruptions containing vellus hair. These cysts are rare developmental abnormalities of vellus hair follicles.

In the year 1977, Nancy B. Esterly, David F. Fretzin and Hermann Pinkus observed hyperpigmented monomorphous papular eruption containing multiple fragmented vellus hair shafts in two children. They proposed the term eruptive vellus hair cysts for this condition.

Eruptive vellus hair cysts are usually asymptomatic and appear as small, 1-3 mm, follicular, atypical, acneiform papules on the central chest and abdomen. The papules are usually flesh colored or hyperpigmented. They may also appear bluish gray, yellow or brown. They are usually localized to the chest, abdomen and flexor aspects of the extremities. In some patients the papules may be generalized and cover extensive areas of the body. Occasional pruritus or tenderness may be present.

Eruptive vellus hair cysts onset ranges from birth to late teens. Teenagers are the most affected age group and have cosmetic concerns. EVHCs does not have gender or race predilection.

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About 25% of the papules may resolve by themselves. Some lesions may persist for years together. In some patients the condition is found to be familial. It presents as an autosomal dominant inheritance, being present at birth or arising during infancy.

Eruptive cysts diagnosis

The lesions can be diagnosed by punch biopsy and histopathological examination. The small intradermal eruptive cysts are lined by two or three layers of squamous epithelium. The cavity contains keratinous material and multiple transversely fragmented vellus hairs. The lesion is devoid of sebaceous glands. The clinical differential diagnosis include acne, milia, mollluscum contagiosum, infundibular cysts and steatocystoma multiplex. The later two conditions though commonly affect the chest skin, do not involve vellus shafts. Steatocystoma multiplex involves the sebaceous duct.

Eruptive cysts causes

The pathogenesis of the eruptive cysts is not clear. It is believed that developmental abnormalities of vellus follicles causes their occlusion leading to retention of strands, follicle dilation and atrophy of the bulb. The follicles appear to be blocked at the level of infundibulum. There are no triggering factors.

Eruptive vellus hair cysts treatment

The treatment modalities include topical applications of keratolytic agents, incision and drainage, curettage, cryotherapy, dermabrasion and laser ablation.

• Application of topical tretinoin or topical tazarotene cream on the affected area had given fairly good results.
• Application of lactic acid or urea cream also had given significant clearance of the cysts.
• Oral isotretinoin or systemic vitamin A treatment did not produce encouraging results.
• Dermabrasion treatment of the affected area though opens up the cysts for draining the contents, does not remove the cysts leading to recurrence of the condition.

Surgical treatment procedures

Simple excision or needle evacuation of the eruptive cyst is done, if necessary after applying a topical anesthetic. These treatment procedures are helpful in the diagnosis of the lesions.

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As the eruptive cysts are to be eliminated individually, this treatment procedure is effective only when the number of lesions are less in number. These procedures cannot be carried out in cases of numerous lesions.

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Treatment with carbon dioxide laser vaporization was tried successfully, and the lesions did not reappear. There was minimal hyperpigmentation after the treatment. Pulsed erbium:yttrium-aluminum-garnet (Er:YAG) laser treatment was successfully used to drill the cysts and the contents were extracted with a forceps. The cavity is again ablated to remove the remnants, if any. Treatment with nonablative 1540 Er:Glass laser was also tried with greater success in removing the eruptive cysts.

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Reference:
1.Swapna Khatu, Resham Vasani, and Shital Amin. Eruptive vellus hair cyst presenting as asymptomatic follicular papules on extremities. Indian Dermatol Online J. 2013 Jul-Sep; 4(3): 213–215.
2.Kaya TI, Tataroglu C, Tursen U, Ikizoglu G. Eruptive vellus hair cysts: an effective extraction technique for treatment and diagnosis. J Eur Acad Dermatol Venereol. 2006 Mar;20(3):264-8.

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