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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Current topic in natural skin care: Eruptive vellus hair cysts in chest and body.

Vellus hair definition - What is vellus hair?

Home   ›   Eruptive vellus hair cysts   ›   What is vellus hair and its definition.

What is vellus hair?

Vellus hair, colloquially also known as 'peach fuzz', is fine and short strand growing on the body right from childhood. Vellus strands, lacking melanin, are usually unpigmented, light-colored and nearly transparent.

Peach fuzz typically refers to the light colored short hair found on the upper lip of young preadolescent boys. Three types of hairs are present in the human body, namely lanugo, vellus and terminal types. The soft strands can be clearly distinguished from terminal type, which is darker, thicker and longer. It can also be distinguished from lanugo type found on fetus. The lanugo is thicker and longer. The fetus sheds lanugo at 30-36 weeks to be replaced by vellus type. In premature babies lanugo may be seen at birth.

The number of vellus follicles and their distribution in the body are predetermined genetically. Its transformation into terminal type is governed by the gender of the individual, puberty and androgen hormones input. During puberty increase in androgenic hormones cause them to convert into terminal ones in the axillary and pubic areas. During the transition to terminal type, intermediate type of strands can be seen. The soft, light strand's length usually does not exceed 2 mm. due to very short anagen phase.

Vellus hair

Vellus follicles, unlike the terminal follicles, do not connect to sebaceous glands. In children, excluding scalp, eyebrows and eyelashes, the body hair is predominantly soft and short. Vellus is very much apparent is children and women. In men they get reduced due to their transformation into terminal ones, whose presence also obscures the presence of those remaining strands. The vellus strands have many functions such as, body insulation, temperature regulation by aiding sweat evaporation and aiding in the perception of touch sensation.

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Web definition of vellus hair

Definition by thefreedictionary.com: "Short, fine, usually nonpigmented which covers much of the body."

Definition by yourdictionary.com: "Short, fine, light-colored, and barely noticeable hair that develops on most of a person's body from his/her childhood."

Definition by collinsdictionary.com: "short fine unpigmented hair covering the human body."

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Medical conditions involving vellus hair

Accelerated vellus syndrome means a condition wherein the anagen phase of the soft, short strands is extended and accelerated. In this accelerated syndrome the slender light colored downy strands gain length. Accelerated syndrome may occur due certain medications as well as abnormal hormonal activity in postmenopausal women and transgender patients.

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In women with polycystic ovarian syndrome, accelerated syndrome may appear which subsequently convert them into terminal types. This accelerated syndrome is also seen with abundance of vellus as a side effect of diseases like Cushing's syndrome and anorexia nervosa. In male pattern baldness, the bald area is not hairless. The growth of thick, dark terminal strands slow down and the light-colored short vellus strands takeover and cover the bald area.

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Reference:
1.Lacarrubba F, Micali G, Tosti A. Absence of vellus in the hairline: a videodermatoscopic feature of frontal fibrosing alopecia. Br J Dermatol. 2013 Aug;169(2):473-4. doi: 10.1111/bjd.12316.
2.Vogt A, Hadam S, Heiderhoff M, Audring H, Lademann J, Sterry W, Blume-Peytavi U. Morphometry of human terminal and vellus follicles. Exp Dermatol. 2007 Nov;16(11):946-50.

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Author: Svdmolen | License: CC BY-SA 3.0
Current topic in natural skin care: What is vellus hair and its definition.