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Dermoscopy of Trichostasis Spinulosa

Lucia Pozo, MD, PhD; Jonathan Bowling, FRCP; Conal M. Perrett, MRCP; Richard Bull, FRCP; Salvador J. Diaz-Cano, MD, PhD, FRCPath
Arch Dermatol. 2008;144(8):1088. doi:10.1001/archderm.144.8.1088.
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Trichostasis spinulosa (TS) is a relatively common but underdiagnosed disorder of hair follicles that retain successive telogen hairs. It has been described within skin lesions (secondary TS) or as an isolated finding (primary TS). Dermoscopy may help identify the characteristic hair tuft. We report 2 cases of TS.

The first case involved a 23-year-old woman who presented with a long-standing history of a light-brown papule on the lower part of her back. There was a black punctum in the upper central area of the lesion (Figure 1). Dermoscopy showed a sparse pigment network, multiple commalike blood vessels that are typical of intradermal melanocytic nevi, a few peripheral vellous hairs, and a small hair tuft emerging from the central punctum (Figure 2). Histologic examination confirmed the presence of an intradermal melanocytic nevus along with dilated folliculosebaceous units containing several cross-sectioned hair shafts (Figure 3). The second case involved a 30-year-old man who presented with a micropapular eruption on both flanks. Dermoscopy showed multiple vellous hairs erupting through the follicles (Figure 4).

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Figure 1.

Intradermal nevus revealing a central punctum.

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Figure 2.

Dermoscopic examination shows a hair tuft corresponding to the dark punctum (original magnification ×10 [inset, ×15]).

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Figure 3.

Histologically, an intradermal melanocytic nevus was observed, revealing multiple hair shafts in a central dilated follicle (hematoxylin-eosin, original magnification ×200).

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Figure 4.

Dermoscopic image of multiple hair shafts emerging from a dilated pore (original magnification ×10).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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