10.5826/dpc.1301a51
text/xml
2160-9381
2546
en
Marina O’ Kane
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
An Incidental Finding of Pili-Multi Gemini of the Back
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-01-31
2022-04-18
2023-01-31
2023-03-01
e2023051
Dermatol Pract Concept
Marina O’ Kane
2023/01/31
10.5826/dpc.1301a51
e2023051
Department of Dermatology, Beaumont Hospital, Dublin, Ireland
2160-9381
en
e2023051
Lester L, Venditti C. The prevalence of pili multigemini. Br J Dermatol. 2007;156(6):1362-1362. DOI: 10.1111/j.1365-2133.2007.07868.
An Incidental Finding of Pili-Multi Gemini of the Back
https://dpcj.org/index.php/dpc/article/download/2546/1924
              An Incidental Finding of Pili-Multi Gemini
                             of the Back
        Anna Wolinska1, Paula Beatty1, Gregg Murray3, Helen Barrett2, Marina O’ Kane1


1 Department of Dermatology, Beaumont Hospital, Dublin, Ireland
2 Department of Histopathology, Beaumont Hospital, Dublin, Ireland
3 Department of Dermatology, Our Lady of Lourdes Hospital, County Louth, Drogheda, Ireland



Citation: Wolinska A, Beatty P, Murray G, Barrett HL, O’ Kane M. An Incidental Finding of Pili-Multi Gemini of the Back. Dermatol Pract
Concept. 2023;13(1):e2023051. DOI: https://doi.org/10.5826/dpc.1301a51
Accepted: June 11, 2022; Published: January 2023
Copyright: ©2023 Wolinska et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Anna Wolinska, Department of Dermatology, Beaumont Hospital, Dublin, Ireland.
E-mail: annawolinska@alumnircsi.com




Case Presentation                                                        Teaching Point
A 57-year-old man presented with a blue, pigmented patch                 Pili multigemini is an unusual hair follicle dysplasia, charac-
across the left upper back. This was clinically consistent with          terized by clusters of shafts that emerge from a single follicle.
nevus of Ito (Figure 1A). On closer inspection with dermos-              Folliculitis may also be present. Diagnosis is clinical. Dermos-
copy short, dark, tufted hairs were identified which were                copy or trichoscopy is helpful for visualizing multiple hairs
widespread across the entire back. Multiple hairs measuring              emerging from the same follicular opening. Electron micros-
< 1 mm arose from each follicular opening (Figure 1B). This              copy shows multiple distorted hair shafts within a common
finding was isolated to the back. There was no history of                root sheath. Treatment with permanent, laser ablative tech-
prior hair removal to otherwise explain this appearance. A               niques can be considered for cosmesis. It is rarely described in
clinical diagnosis of widespread pili multigemini was made.              the literature due to under-reporting in clinical practice and is
    Skin punch biopsy was performed which confirmed the                  most commonly found in male facial hair [1,2].
clinical diagnosis. Treatment was not indicated as the patient                Dermatologists should be vigilant for pathology that may
was asymptomatic at time of diagnosis.                                   be hidden within concomitant skin changes and this case




Image Letter | Dermatol Pract Concept. 2023;13(1):e2023051                                                                              1
 Figure 1. (A) 15 cm blue pigmented patch distributed across the left upper back with visible widespread dark, follicular changes.
 (B) Dermoscopy demonstrating multiple 0.5mm-1mm tufted hairs arising from within each follicular opening.




emphasizes the importance of thorough full skin examination        References
enhanced by the use of dermoscopy. It raises the discussion
of whether pili multigemini represents a true, rare phenome-        1. Ciudad-Blanco C, Heffernan J, Montero E et al. Extensive pili
                                                                       multigemini over the back. Int J Trichology. 2014;6(4):180-181.
non or underdiagnosis due to its a­ symptomatic nature.
                                                                       DOI: 10.4103/0974-7753.142871. PMID: 25368477; P       ­ MCID:
                                                                       PMC4212297.
                                                                    2. Lester L, Venditti C. The prevalence of pili multigemini. Br
                                                                       J Dermatol. 2007;156(6):1362-1362. DOI: 10.1111/j.1365-
                                                                       2133.2007.07868. MID: 17441959.




2                                                                         Image Letter | Dermatol Pract Concept. 2023;13(1):e2023051
