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Year : 2021  |  Volume : 22  |  Issue : 4  |  Page : 385-386

Eruptive vellus hair cyst: Treatment with topical tretinoin 0.025% cream

Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India

Date of Submission28-Apr-2021
Date of Decision17-May-2021
Date of Acceptance01-Jun-2021
Date of Web Publication01-Oct-2021

Correspondence Address:
Rashmi Agarwal
Cutis Academy of Cutaneous Sciences, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpd.ijpd_61_21

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How to cite this article:
Agarwal R, Suganya S, Chandrashekar B S. Eruptive vellus hair cyst: Treatment with topical tretinoin 0.025% cream. Indian J Paediatr Dermatol 2021;22:385-6

How to cite this URL:
Agarwal R, Suganya S, Chandrashekar B S. Eruptive vellus hair cyst: Treatment with topical tretinoin 0.025% cream. Indian J Paediatr Dermatol [serial online] 2021 [cited 2021 Dec 6];22:385-6. Available from: https://www.ijpd.in/text.asp?2021/22/4/385/327456


Eruptive vellus hair cysts (EVHCs) are uncommon cutaneous lesions first described in 1977 by Esterly et al.[1] They manifest clinically with multiple, small papules with a smooth or centrally umbilicated surface and pathologically diagnosed with epidermoid cysts along the vellus hairs.[2]

A case of EVHC in a 4-year-old girl was reported previously by us.[3] There were multiple small skin-colored to reddish-brown, firm, hyperkeratotic papules on the chest, axilla, and lateral part of the trunk [Figure 1] and [Figure 2]a. Diagnosis of EVHC was made based on classical dermoscopic (reddish-brown oval structures surrounded by erythematous to brownish halos with eccentrically placed pores and blue homogeneous areas) and histopathological features (dermal cysts lined by the stratified squamous epithelium, filled with laminated keratin and vellus hair shafts). The child was started on oral isotretinoin 10 mg daily for the same. She visited us after 1 year, and there was near-complete resolution of the lesions. Oral isotretinoin was taken for 2 months and thereby stopped because of severe cheilitis. She was then started on topical tretinoin 0.025% cream once daily. After 3 months of daily application of the cream, there was noticeable improvement in the EVHC lesions [Figure 2]b and [Figure 3]. Topical tretinoin 0.025% was continued for another 2 months and then stopped. The child is under regular follow-up, and there is no recurrence of the lesions.
Figure 1: (a and b) A 4 year old girl with multiple small reddish-brown to skin-colored discrete hyperkeratotic papules on bilateral axilla and trunk

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Figure 2: Multiple discrete reddish-brown hyperkeratotic papules on the chest (a) responded well to treatment with topical tretinoin 0.025% cream with near-complete resolution of the lesions (b)

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Figure 3: Resolution of lesions of eruptive vellus hair cyst on the axillary area following treatment with topical tretinoin 0.025% cream

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The cysts of EVHC resolve spontaneously in around 25% of patients due to inflammatory response and transepidermal elimination. Several treatment options such as topical keratolytic agents (retinoic acid 0.05%, tazarotene cream 0.1%, tretinoin 0.1% cream, urea 10%, or lactic acid 12%), topical calcipotriene, oral isotretinoin, CO2, or erbium: YAG laser ablation have been reported to be effective for EVHC. Topical Vitamin A analogs and surgical approaches have shown the best outcome according to the literature. Laser therapy may result in scarring in cases of EVHC and thus should be used with caution. Treatment modalities such as dermabrasion, surgical incision and drainage, and needle evacuation using an 18G needle have also been tried.[4] Saks and Levitt compared the effect of erbium: YAG laser with topical tazarotene 0.1% cream and incision and drainage for the treatment of EVHC in a 6-year-old girl and observed that tazarotene 0.1% cream applied twice daily for 2 weeks was more effective and less invasive as compared with erbium: YAG and incision and drainage.[5] EVHC is frequently misdiagnosed due to its rarity, and this case highlights the importance of keeping EVHC as a differential while examining asymptomatic papules on the trunk of a child. Topical retinoids can prove to be a very effective and noninvasive method for treating EVHC in children as seen in the present case.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the parents have given their consent for images and other clinical information to be reported in the journal. The parents understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Esterly N, Fretzin D, Pinkus H. Eruptive vellus hair cysts. Arch Dermatol 1977;113:500-3.  Back to cited text no. 1
Torchia D, Vega J, Schachner L. Eruptive vellus hair cysts: a systematic review. Am J Clin Dermatol 2012;13:19-28.  Back to cited text no. 2
Agarwal R, Chandrashekar BS, Desai PB. Eruptive vellus hair cyst: Unveiling the diagnostic features. Indian J Paediatr Dermatol 2020;21:194.  Back to cited text no. 3
  [Full text]  
Haritha K, Parthasaradhi A, Jalu J. Eruptive vellus hair cyst. Indian J Paediatr Dermatol 2016;17:76.  Back to cited text no. 4
  [Full text]  
Saks K, Levitt JO. Tazarotene 0.1 percent cream fares better than erbium: YAG laser or incision and drainage in a patient with eruptive vellus hair cysts. Dermatol Online J 2006;12.  Back to cited text no. 5


  [Figure 1], [Figure 2], [Figure 3]


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