SECTION EDITOR: JAMES M. GRICHNIK, MD, PhD; ASSISTANT SECTION EDITORS: ASHFAQ A. MARGHOOB, MD; ALON SCOPE, MD
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; Homerton University Hospital, London, England (Drs Pozo, Perrett, and Bull);
Churchill Hospital, Oxford, England (Dr Bowling); and King’s College Hospital, London (Dr Diaz-Cano)
RICHOSTASIS SPINULOSA (TS) IS A RELA-
tively common but underdiagnosed disor-
der of hair follicles that retain successive
telogen hairs. It has been described within
skin lesions (secondary TS) or as an iso-
lated finding (primary TS). Dermoscopy may help iden-
tify the characteristic hair tuft. We report 2 cases of TS.
The first case involved a 23-year-old woman who pre-
sented with a long-standing history of a light-brown pap-
ule on the lower part of her back. There was a black punc-
tum in the upper central area of the lesion (
Dermoscopy showed a sparse pigment network, multiple
commalike blood vessels that are typical of intradermal me-
lanocytic nevi, a few peripheral vellous hairs, and a small
hair tuft emerging from the central punctum (
Histologic examination confirmed the presence of an in-
tradermal melanocytic nevus along with dilated folliculo-
sebaceous units containing several cross-sectioned hair
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 (
Hair tufts are the result of folliculosebaceous hamar-
tomas with multiple units around a central pore (tricho-
folliculomas) or retained hair shafts within follicles with
infundibular keratosis (TS). Trichostasis spinulosa may
appear as an isolated finding or in association with ex-
pansile nondestructive lesions that narrow hair infun-
dibulae, such as melanocytic nevi, seborrheic keratoses,
syringomas, or nodular basal cell carcinomas. Dermos-
copy is helpful in diagnosing TS.
Figure 1. Intradermal nevus revealing a central punctum.
Figure 2. Dermoscopic examination shows a hair tuft corresponding to the
dark punctum (original magnification ⫻10 [inset, ⫻15]).
Figure 3. Histologically, an intradermal melanocytic nevus was observed,
revealing multiple hair shafts in a central dilated follicle (hematoxylin-eosin,
original magnification ⫻200).
Figure 4. Dermoscopic image of multiple hair shafts emerging from a dilated
pore (original magnification ⫻10).
(REPRINTED) ARCH DERMATOL/ VOL 144 (NO. 8), AUG 2008 WWW.ARCHDERMATOL.COM
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