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Solitary Nodule With White Hairs
The Diagnosis: Trichofolliculoma
Microscopic examination revealed a dilated cystic follicle that communicated with the skin surface (Figure). The follicle was lined with squamous epithelium and surrounded by numerous secondary follicles, many of which contained a hair shaft. A diagnosis of trichofolliculoma was made.
Clinically, the differential diagnosis of a flesh-colored papule on the scalp with prominent follicle includes dilated pore of Winer, epidermoid cyst, pilar sheath acanthoma, and trichoepithelioma.1,2 Multiple hair shafts present in a single follicle may be seen in pili multigemini, tufted folliculitis, trichostasis spinulosa, and trichofolliculoma. On histopathologic examination, a dilated central follicle surrounded with smaller secondary follicles was identified, consistent with trichofolliculoma.
Trichofolliculoma is a rare follicular hamartoma typically occurring on the face, scalp, or trunk as a solitary papule or nodule due to the proliferation of abnormal hair follicle stem cells.3,4 It may present as a flesh-colored nodule with a central pore that may drain sebum or contain white vellus hairs. Trichofolliculoma is considered a benign entity, despite one case report of malignant transformation.5 Biopsy is diagnostic and no further treatment is needed. Recurrence rarely occurs at the primary site after surgical excision, which may be performed for cosmetic purposes or to alleviate functional impairment.
- Ghosh SK, Bandyopadhyay D, Barma KD. Perifollicular nodule on the face of a young man. Indian J Dermatol Venereol Leprol. 2011;77:531-533.
- Gokalp H, Gurer MA, Alan S. Trichofolliculoma: a rare variant of hair follicle hamartoma. Dermatol Online J. 2013;19:19264.
- Choi CM, Lew BL, Sim WY. Multiple trichofolliculomas on unusual sites: a case report and review of the literature. Int J Dermatol. 2013;52:87-89.
- Misago N, Kimura T, Toda S, et al. A revaluation of trichofolliculoma: the histopathological and immunohistochemical features. Am J Dermatopathol. 2010;32:35-43.
- Stem JB, Stout DA. Trichofolliculoma showing perineural invasion. trichofolliculocarcinoma? Arch Dermatol. 1979;115:1003-1004.
The Diagnosis: Trichofolliculoma
Microscopic examination revealed a dilated cystic follicle that communicated with the skin surface (Figure). The follicle was lined with squamous epithelium and surrounded by numerous secondary follicles, many of which contained a hair shaft. A diagnosis of trichofolliculoma was made.
Clinically, the differential diagnosis of a flesh-colored papule on the scalp with prominent follicle includes dilated pore of Winer, epidermoid cyst, pilar sheath acanthoma, and trichoepithelioma.1,2 Multiple hair shafts present in a single follicle may be seen in pili multigemini, tufted folliculitis, trichostasis spinulosa, and trichofolliculoma. On histopathologic examination, a dilated central follicle surrounded with smaller secondary follicles was identified, consistent with trichofolliculoma.
Trichofolliculoma is a rare follicular hamartoma typically occurring on the face, scalp, or trunk as a solitary papule or nodule due to the proliferation of abnormal hair follicle stem cells.3,4 It may present as a flesh-colored nodule with a central pore that may drain sebum or contain white vellus hairs. Trichofolliculoma is considered a benign entity, despite one case report of malignant transformation.5 Biopsy is diagnostic and no further treatment is needed. Recurrence rarely occurs at the primary site after surgical excision, which may be performed for cosmetic purposes or to alleviate functional impairment.
The Diagnosis: Trichofolliculoma
Microscopic examination revealed a dilated cystic follicle that communicated with the skin surface (Figure). The follicle was lined with squamous epithelium and surrounded by numerous secondary follicles, many of which contained a hair shaft. A diagnosis of trichofolliculoma was made.
Clinically, the differential diagnosis of a flesh-colored papule on the scalp with prominent follicle includes dilated pore of Winer, epidermoid cyst, pilar sheath acanthoma, and trichoepithelioma.1,2 Multiple hair shafts present in a single follicle may be seen in pili multigemini, tufted folliculitis, trichostasis spinulosa, and trichofolliculoma. On histopathologic examination, a dilated central follicle surrounded with smaller secondary follicles was identified, consistent with trichofolliculoma.
Trichofolliculoma is a rare follicular hamartoma typically occurring on the face, scalp, or trunk as a solitary papule or nodule due to the proliferation of abnormal hair follicle stem cells.3,4 It may present as a flesh-colored nodule with a central pore that may drain sebum or contain white vellus hairs. Trichofolliculoma is considered a benign entity, despite one case report of malignant transformation.5 Biopsy is diagnostic and no further treatment is needed. Recurrence rarely occurs at the primary site after surgical excision, which may be performed for cosmetic purposes or to alleviate functional impairment.
- Ghosh SK, Bandyopadhyay D, Barma KD. Perifollicular nodule on the face of a young man. Indian J Dermatol Venereol Leprol. 2011;77:531-533.
- Gokalp H, Gurer MA, Alan S. Trichofolliculoma: a rare variant of hair follicle hamartoma. Dermatol Online J. 2013;19:19264.
- Choi CM, Lew BL, Sim WY. Multiple trichofolliculomas on unusual sites: a case report and review of the literature. Int J Dermatol. 2013;52:87-89.
- Misago N, Kimura T, Toda S, et al. A revaluation of trichofolliculoma: the histopathological and immunohistochemical features. Am J Dermatopathol. 2010;32:35-43.
- Stem JB, Stout DA. Trichofolliculoma showing perineural invasion. trichofolliculocarcinoma? Arch Dermatol. 1979;115:1003-1004.
- Ghosh SK, Bandyopadhyay D, Barma KD. Perifollicular nodule on the face of a young man. Indian J Dermatol Venereol Leprol. 2011;77:531-533.
- Gokalp H, Gurer MA, Alan S. Trichofolliculoma: a rare variant of hair follicle hamartoma. Dermatol Online J. 2013;19:19264.
- Choi CM, Lew BL, Sim WY. Multiple trichofolliculomas on unusual sites: a case report and review of the literature. Int J Dermatol. 2013;52:87-89.
- Misago N, Kimura T, Toda S, et al. A revaluation of trichofolliculoma: the histopathological and immunohistochemical features. Am J Dermatopathol. 2010;32:35-43.
- Stem JB, Stout DA. Trichofolliculoma showing perineural invasion. trichofolliculocarcinoma? Arch Dermatol. 1979;115:1003-1004.
A 72-year-old man presented with a new asymptomatic 0.7-cm flesh-colored papule with a central tuft of white hairs on the posterior scalp. The remainder of the physical examination was unremarkable. Biopsy for histopathologic examination was performed to confirm diagnosis.
