Eruptive vellus hair cyst and epidermoid cyst in a patient with pachyonychia congenita

Stüve-Wiedemann syndrome with multiple eruptive vellus hair cysts and clefted tongue

Stüve-Wiedemann syndrome is a rare autosomal recessive congenital primary skeletal dysplasia, characterized by small stature, bowed long bones, joint restrictions, hyperthermic episodes, dysautonomia, and respiratory and feeding difficulties, that usually leads to early mortality. Cutaneous manifestations have rarely been reported. We report the case of a girl with Stüve-Wiedemann syndrome presenting with progressive development of multiple eruptive vellus hair cysts.

Eruptive vellus hair cysts: a systematic review

We report the results of the first systematic review of the worldwide literature on eruptive vellus hair cysts (EVHC). It is likely that EVHC are less rare than it may appear from the scarcity of related publications in the literature. EVHC may be present at birth and may appear at any age, although they show a clear trend towards occurring during the first 3 decades of life. A strong clue to the heavy influence of genes on the occurrence of EVHC is provided by the numerous reports of families in whom two or more members were affected. EVHC lesions present clinically in a rather monomorphous fashion, i.e. round, dome-shaped, skin-colored, asymptomatic, soft-tender papules with a smooth surface and grouped or disseminated in a symmetric pattern. EVHC may affect any cutaneous area, even if the upper part of the body and some distribution patterns are particularly frequent and recognizable, i.e. cephalic, upper trunk around the midline, upper limb including axillae, and proximal lower limb. Such a distribution is likely not random and seems to grossly overlap with that of pilosebaceous and apocrine units. Like clinical morphology, the histologic features of EVHC papules are rather monomorphous, indeed, the diagnostic hallmark being the presence of vellus hair shafts within the cystic space. Peculiar subgroups (familial, late-onset, unilesional, and associated with steatocystoma multiplex) are also identified and discussed. In conclusion, EVHC are basically a cosmetic concern to patients but represent a chronic and difficult-to-treat condition. On the basis of our review, future studies are warranted, mainly concerning (i) further nosographic framing involving genetic and tissue analysis, (ii) implementation of non-invasive diagnostic procedures, and (iii) therapeutic trials of interventions shown to achieve some effectiveness.

Early recurrence of eruptive vellus hair cysts after Er:YAG laser therapy: case report and review of the literature

BACKGROUND

Therapy of eruptive vellus hair cysts (EVHCs) often leads to unsatisfying results or recurrences. Recently, erbium:yttrium-aluminum-garnet (Er:YAG) laser therapy has been recommended in this condition.

OBJECTIVE

To report the results of Er:YAG laser treatment and discuss the treatment options in EVHC, presenting a review of the literature.

METHODS

Full-face Er:YAG laser therapy was performed in a 30-year-old female patient with a 15-year history of cosmetically bothersome facial EVHCs.

RESULTS

Immediately after the laser treatment, the ablated skin showed an even surface, presenting no residual signs of EVHCs. After reepithelialization, however, early recurrence of EVHCs occurred. Recurrence was also observed in the previously treated test spot, where slight atrophy indicated deeper ablation.

CONCLUSION

Er:YAG laser therapy might be a treatment option for distinct lesions of EVHCs but proved to be ineffective in a case of EVHCs in the face, where the depth of ablation is limited owing to the risk of atrophy or scarring and where deep enucleation of distinct single cysts was not possible owing to the dense dissemination of the lesions. Despite numerous treatment options reported in the literature, therapy for EVHCs is still challenging owing to recurrences or side effects.