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KMID : 0363220170550080551
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Korean Journal of Dermatology
2017 Volume.55 No. 8 p.551 ~ p.553
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Eruptive Vellus Hair Cysts Successfully Treated by Topical Tretinoin 0.01% Cream
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Jun Ji-Young
Oh Se-Jin
Oh Seung-Hwan
Shim Joon-Ho
Park Ji-Hye
Lee Jong-Hee
Lee Dong-Youn
Lee Joo-Heung
Yang Jun-Mo
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Abstract
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A 4-year-old Asian boy presented with 1- to 3-mm sized multiple brownish papules on the mid-chest (Fig. 1A). Papules first presented 1 year prior and progressively spread. No other family members were affected, including his twin sister.
Punch biopsy revealed a cyst in the papillary dermis (Fig. 2A) lined by squamous epithelium with an attenuated granular layer. Inside the cyst, vellus hair shafts and laminated keratin were found (Fig. 2B). We diagnosed eruptive vellus hair cysts (EVHCs) based on clinical manifestation, young age, and histopathological results.
Tretinoin 0.01% cream was applied admixed with moisturizer in 1：1 ratio. After 6 months, lesions improved dramatically. Hyperpigmentation on the background skin disappeared (Fig. 1B). No side effect was noted.
EVHCs are benign dermal cysts that are often difficult to treat. Surgical removal and laser therapy are somewhat effective but painful. They often result in scarring and postinflammatory hyperpigmentation. Systemic agents such as oral isotretinoin and vitamin A are ineffective1. Treatment with topical agents has advantages over previously stated methods because it is non-invasive and has fewer side effects. In one report, tazarotene 0.1% cream was found to be better than the erbium:yttrium aluminum garnet (Er:YAG) laser in that tazarotene cream resulted in similar improvements with less post-inflammatory hyperpigmentation2. In our case, tretinoin even led to fading of hyperpigmentation. To our knowledge, there are seven cases in the English literature reporting the use of topical tretinoin cream on EVHCs with variable success3-5. However, none clearly documented patient outcomes by publishing their photographs. In our patient, tretinoin cream resulted in a stunningly successful outcome despite the low concentration used. The reason for the good response might be attributable to relatively thin epidermis due to the young age of the patient, and the superficial location of the cysts with some situated close to epidermis, and openings had been exposed in several cysts. One previous case report showed faster and more complete treatment response in superficial EVHCs with openings than in deeper EVHCs5. Six months of treat- ment duration might be another factor responsible for the good outcome, because other previously reported cases applied tretinoin cream for 4 months or less.
Among the many treatment modalities of EVHCs, tretinoin cream might be a good first choice option because it is safe and well-tolerated even in children. The optimal treatment duration and optimal treatment indications depending on the depth of the cyst need to be elucidated in future studies.
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KEYWORD
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Follicular cyst, Treatment outcome, Tretinoin
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