10.5826/dpc.1301a26
text/xml
2160-9381
2299
en
XiaoPo Wang
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
reflectance confocal microscopy
Two new dermoscopic features of trichostasis spinulosa and its reflectance confocal microscopic appearance 
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-01-31
2022-01-06
2023-01-31
2023-02-27
e2023026
Dermatol Pract Concept
XiaoPo Wang
2023/01/31
10.5826/dpc.1301a26
e2023026
Department of Pathology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital of Skin Diseases and Institute of Dermatology, Jiangsu, China 
2160-9381
reflectance confocal microscopy
en
e2023026
Panchaprateep R, Tanus A, Tosti A. Clinical, dermoscopic, and histopathologic features of body hair disorders. J Am Acad Dermatol. 2015;72(5):890-900. DOI: 10.1016/j.jaad.2015.01.024. PMID: 25748313.
Two new dermoscopic features of trichostasis spinulosa and its reflectance confocal microscopic appearance 
https://dpcj.org/index.php/dpc/article/download/2299/1905
       Two New Dermoscopic Features of Trichostasis
          Spinulosa and Its Reflectance Confocal
                 Microscopic Appearance
                           Xuemei Lan1, Jianfang Sun1, Yiqun Jiang1, Xiaopo Wang1


1 Department of Pathology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital of Skin Diseases and Institute
  of Dermatology, Jiangsu, China



Key words: Trichostasis spinulosa, dermoscopy, reflectance confocal microscopy
Citation: Lan X, Sun J, Jiang Y, Wang X. Two New Dermoscopic Features of Trichostasis Spinulosa and Its Reflectance Confocal
Microscopic Appearance. Dermatol Pract Concept. 2023;13(1):e2023026. DOI: https://doi.org/10.5826/dpc.1301a26
Accepted: April 7, 2022; Published: January 2023
Copyright: ©2023 Lan 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: Yiqun Jiang, Emails: yiqunjiang@qq.com; Xiaopo Wang, Emails: 13770757675@163.com. Department of
Pathology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital of Skin Diseases and Institute of Dermatology,
12 Jiangwangmiao Street, Nanjing, Jiangsu, 210042, China.




Introduction                                                             firm, discrete, 0.2-0.5 mm follicular keratotic papules on
                                                                         the abdomen and back (Figure 1, A and B). Histopathology
Trichostasis spinulosa (TS) is a relatively common yet un-               revealed hyperkeratosis with follicular plugging, a dilated
recognized follicular disorder characterized by the retention            infundibulum containing multiple vellus hairs enveloped in
of numerous vellus hairs surrounded by a hyperkeratotic di-              keratinous material (Figure 1C). The microscopic examination
lated hair follicle [1]. The main dermoscopic structures of TS           illustrated a cluster of vellus hairs embedded in keratinous ma-
have been identified previously [2]. Herein, we identify two             terial from an extracted plug (Figure 1D). Dermoscopy demon-
new dermoscopic features of TS and report its reflectance                strated a bundle of vellus hairs projecting together (Figure 2A)
confocal microscopy (RCM) characteristics for the first time.            and keratotic plugs in some dilated follicles. In addition, dark
                                                                         concentric hair forming a circle under the horny layer (circle
                                                                         hair) and hairs rolled in spiral with peripilar casts (rolled hair)
Case Presentation
                                                                         were also seen (Figure 2, B and C). RCM showed dilated fol-
A 25-year-old woman complained of progressive multiple,                  licular openings were consisted of moderate-­refractive kera-
black-colored keratotic lesions with mild pruritus involving             totic substitutes and/or hyper-refractive numerous vellus hairs
her trunk for 2 years. Her medical history was otherwise un-             ­(Figure 2, D and E). Based on the above findings, the diagnosis
remarkable. Physical examination revealed numerous black,                was consistent with TS.




Research Letter | Dermatol Pract Concept. 2023;13(1):e2023026                                                                             1
Figure 1. (A,B) Multiple dark-brownish keratotic follicular papules distributed on the abdomen and back. (C) Histopathology revealed
­several vellus hairs in follicular plugging (H&E x100); (D) Microscopic examination showed several hair shafts blocked in one follicle (x100).




Conclusions                                                              new dermoscopic findings of TS: circle hair and rolled hair.
                                                                         Circle hair is almost exclusively found incidentally on the
Two clinical variants of TS have been proposed, namely non-              trunk and upper legs of overweight men, where they are in-
pruritic and pruritic type [3]. We present a patient classified          terspersed with normal hairs [4]. Rolled hair is associated
as pruritic type which usually affects young adult character-            with many conditions such as ichthyosis, keratosis pilaris,
ized by multiple itchy follicular papules mainly on the trunk            xerosis, neurodermatitis, and palmoplantar keratoderma [5].
and upper limbs. The diagnosis of TS is usually based on clin-           Some authors attributed rolled hair to mechanical trauma
ical presentation, microscopy and sometimes on histopathol-              resulting from repeated and vigorous rubbing.
ogy. However, dermoscopy is the most helpful tool in clinical                RCM is a high-resolution imaging technique which al-
practice. The main dermoscopic characteristics of TS, includ-            lows in vivo visualization of upper layers of skin structures.
ing tufts of short, vellus hairs emerging together and keratotic         However, the RCM characteristics of TS have not been de-
plugs of some follicular openings, were noticed in our patient           scribed so far. In this study, we observed RCM features as
as previously described [2]. Furthermore, we observed two                moderate-refractive and hyper-refractive structures among




2                                                                             Research Letter | Dermatol Pract Concept. 2023;13(1):e2023026
Figure 2. (A-C) Dermoscopy demonstrated tufts hairs (black arrows), rolled hairs (red arrows), circle hairs (blue arrows), and blackhead-like
structures (yellow arrows) (x10). (D-E) reflectance confocal microscopy illustrated an oval-shaped moderate-refractive structure (red arrows)
in the epidermis and hyper-refractive piliform structures (blue arrows) among dilated follicular openings (basic image, 0.5mm × 0.5mm).




Research Letter | Dermatol Pract Concept. 2023;13(1):e2023026                                                                              3
dilated follicular openings, corresponding well to histologic               study of 306 patients. Skin Appendage Disord. 2018;4(4):­
horny follicular plugs and tufts vellus hairs, respectively.                291-295. DOI: 10.1159/000486541. PMID: 30410899.​­PMCID:
                                                                            PMC6219231.
    In conclusion, we have proposed two new dermoscopic
                                                                         3. Kositkuliorn C, Suchonwanit P. Trichostasis spinulosa: a case report
signs of TS and its RCM features. These techniques, com-
                                                                            with an unusual presentation. Case Rep Dermatol. 2020;12(3):
bined with the clinical findings, may be useful to diagnosis                178-185. DOI: 10.1159/000509993. PMID: 33250734. PMCID:
of TS, possibly limiting the need for skin biopsy.                          PMC7670378.
                                                                         4. Esteves ALV, Serafini NB, Lemes LR, et al. Circular hairs: nomen-
                                                                            clature and meanings. An Bras Dermatol. 2017;92(6):874-876.
References                                                                  DOI: 10.1590/abd1806-4841.20176487. PMID: 29364454.
1. Goldust M, Wollina U, Bhargava S, et al. Trichostasis spinu-             PMCID: PMC5786412.
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