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Minoxidil-Induced Trichostasis Spinulosa of Terminal Hair

Minoxidil-Induced Trichostasis Spinulosa of Terminal Hair Report of a Case A 35-year-old woman with female pattern hair loss and a history of regular use of topical minoxidil, 2%, to the crown area for the previous 13 years was referred to us by her dermatologist for suspected factitial cutting of the hair (trichotemnomania) in the temporal regions. In fact, she had extended the application area of minoxidil to encompass the temporal and high frontal regions for years before coming to us out of fear of hair loss in these areas. On examination, we observed androgenetic alopecia of mixed pattern with conspicuous multiple follicular blackish hair bristles the size of pinheads (0.5-1.0 mm) in the frontal region of the hairline and on both temples (Figure). Dermoscopic examination (original magnification ×10) revealed tufts of pigmented terminal hair of varying diameters emerging from each hair follicle (Figure).1 A biopsy specimen revealed a terminal hair follicle with dilated infundibulum containing hyperkeratotic material and several detached hair shafts within a keratinous sheath (Figure). The diagnosis of trichostasis spinulosa of the terminal hair type was made. Figure. View LargeDownload Minoxidil-induced trichostasis spinulosa of terminal hair. A, Temporal region shows multiple small blackish spines extruding from hair follicle openings. The dotted line indicates the approximate area of minoxidil application; the asterisk indicates the approximate region evaluated by dermoscopy and shown in the inset at original magnification ×10. The further-enlarged area within the magnified inset area is original magnification ×50. B, Dermatopathologic specimen of an excised spine showing a terminal hair follicle with dilated infundibulum containing hyperkeratotic material and several detached hair shafts within a keratinous sheath ((hematoxylin-eosin, original magnification ×100). Comment Trichostasis spinulosa is a follicular disorder resulting from the retention of numerous hairs surrounded by a keratinous sheath in a dilated follicle (Table).2,3 It was first recognized by German dermatologist Franke4 in 1912, who named it Pinselhaar or thysanothrix for the similarity to a paintbrush (German, Pinsel) or fringes (Greek, thysanos). The term trichostasis spinulosa was later introduced by Noble,5 who described 6 cases in 1913 with the classic presentation involving nonitching comedolike lesions usually on the face of elderly people. A second, pruritic variant has been distinguished, characterized by numerous itchy, keratotic, follicular papules the size of pinheads, mainly located on the trunk and upper arms of young adults.2 Male and female patients are equally affected.3 Table. View LargeDownload Possible Causes of Trichostasis Spinulosaa The diagnosis is easily made by microscopic examination of the contents of a papule extracted by a pair of tweezers, typically revealing a bundle of more than 6 vellus hairs surrounded by a keratinous sheath.2 These retained hairs are in the telogen phase of the hair cycle. Hair shedding is prevented or delayed by hyperkeratosis (congenital or acquired), abnormal hair follicle angulation, or follicle damage from external factors. Other conditions considered in the differential diagnosis of trichostasis spinulosa include keratosis pilaris, ichthyosis follicularis, hypovitaminosis A (phrynoderma) or C, eruptive vellus hair cysts, and dyskeratosis follicularis.3 The retention of vellus hairs can be physiologic in some skin regions such as the belt region due to regular local pressure preventing normal shedding of hairs.2 The special feature of our case was the manifestation of trichostasis spinulosa with the paintbrush hairs originally described by Franke4 but in the absence of papules. Moreover, involved hairs were of the terminal hair type. Minoxidil induces hair follicles to undergo the transition from early to late anagen phase and can transform vellus hairs to terminal hairs.6 We believe that the retained vellus hairs of typical trichostasis spinulosa were induced to transform into more conspicuous terminal hairs by the effect of the trichotrophic agent minoxidil. Correspondence: Dr Navarini, Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, CH-8091 Zurich, Switzerland (alexander.navarini@usz.ch). Financial Disclosure: None reported. Funding/Support: This study was supported by the Department of Dermatology, University Hospital of Zurich, Zurich. Additional Information: Drs Navarini and Ziegler contributed equally to this article. References 1. Pozo LBowling JPerrett CMBull RDiaz-Cano SJ Dermoscopy of trichostasis spinulosa. Arch Dermatol 2008;144 (8) 1088PubMedGoogle Scholar 2. Strobos MAJonkman MF Trichostasis spinulosa: itchy follicular papules in young adults. Int J Dermatol 2002;41 (10) 643- 646PubMedGoogle ScholarCrossref 3. Janjua SAMcKoy KCIftikhar N Trichostasis spinulosa: possible association with prolonged topical application of clobetasol propionate 0.05% cream. Int J Dermatol 2007;46 (9) 982- 985PubMedGoogle ScholarCrossref 4. Das Pinselhaar Franke F. Thysanothrix. Dermatol Wochenschr 1912;551269- 1272Google Scholar 5. Noble G Trichostasis spinulosa. Arch Dermatol Syphilol 1913;114 (5) 611- 627Google Scholar 6. Tsuboi RArano ONishikawa TYamada HKatsuoka K Randomized clinical trial comparing 5% and 1% topical minoxidil for the treatment of androgenetic alopecia in Japanese men. J Dermatol 2009;36 (8) 437- 446PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Minoxidil-Induced Trichostasis Spinulosa of Terminal Hair

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Publisher
American Medical Association
Copyright
Copyright © 2010 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archdermatol.2010.363
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Abstract

Report of a Case A 35-year-old woman with female pattern hair loss and a history of regular use of topical minoxidil, 2%, to the crown area for the previous 13 years was referred to us by her dermatologist for suspected factitial cutting of the hair (trichotemnomania) in the temporal regions. In fact, she had extended the application area of minoxidil to encompass the temporal and high frontal regions for years before coming to us out of fear of hair loss in these areas. On examination, we observed androgenetic alopecia of mixed pattern with conspicuous multiple follicular blackish hair bristles the size of pinheads (0.5-1.0 mm) in the frontal region of the hairline and on both temples (Figure). Dermoscopic examination (original magnification ×10) revealed tufts of pigmented terminal hair of varying diameters emerging from each hair follicle (Figure).1 A biopsy specimen revealed a terminal hair follicle with dilated infundibulum containing hyperkeratotic material and several detached hair shafts within a keratinous sheath (Figure). The diagnosis of trichostasis spinulosa of the terminal hair type was made. Figure. View LargeDownload Minoxidil-induced trichostasis spinulosa of terminal hair. A, Temporal region shows multiple small blackish spines extruding from hair follicle openings. The dotted line indicates the approximate area of minoxidil application; the asterisk indicates the approximate region evaluated by dermoscopy and shown in the inset at original magnification ×10. The further-enlarged area within the magnified inset area is original magnification ×50. B, Dermatopathologic specimen of an excised spine showing a terminal hair follicle with dilated infundibulum containing hyperkeratotic material and several detached hair shafts within a keratinous sheath ((hematoxylin-eosin, original magnification ×100). Comment Trichostasis spinulosa is a follicular disorder resulting from the retention of numerous hairs surrounded by a keratinous sheath in a dilated follicle (Table).2,3 It was first recognized by German dermatologist Franke4 in 1912, who named it Pinselhaar or thysanothrix for the similarity to a paintbrush (German, Pinsel) or fringes (Greek, thysanos). The term trichostasis spinulosa was later introduced by Noble,5 who described 6 cases in 1913 with the classic presentation involving nonitching comedolike lesions usually on the face of elderly people. A second, pruritic variant has been distinguished, characterized by numerous itchy, keratotic, follicular papules the size of pinheads, mainly located on the trunk and upper arms of young adults.2 Male and female patients are equally affected.3 Table. View LargeDownload Possible Causes of Trichostasis Spinulosaa The diagnosis is easily made by microscopic examination of the contents of a papule extracted by a pair of tweezers, typically revealing a bundle of more than 6 vellus hairs surrounded by a keratinous sheath.2 These retained hairs are in the telogen phase of the hair cycle. Hair shedding is prevented or delayed by hyperkeratosis (congenital or acquired), abnormal hair follicle angulation, or follicle damage from external factors. Other conditions considered in the differential diagnosis of trichostasis spinulosa include keratosis pilaris, ichthyosis follicularis, hypovitaminosis A (phrynoderma) or C, eruptive vellus hair cysts, and dyskeratosis follicularis.3 The retention of vellus hairs can be physiologic in some skin regions such as the belt region due to regular local pressure preventing normal shedding of hairs.2 The special feature of our case was the manifestation of trichostasis spinulosa with the paintbrush hairs originally described by Franke4 but in the absence of papules. Moreover, involved hairs were of the terminal hair type. Minoxidil induces hair follicles to undergo the transition from early to late anagen phase and can transform vellus hairs to terminal hairs.6 We believe that the retained vellus hairs of typical trichostasis spinulosa were induced to transform into more conspicuous terminal hairs by the effect of the trichotrophic agent minoxidil. Correspondence: Dr Navarini, Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, CH-8091 Zurich, Switzerland (alexander.navarini@usz.ch). Financial Disclosure: None reported. Funding/Support: This study was supported by the Department of Dermatology, University Hospital of Zurich, Zurich. Additional Information: Drs Navarini and Ziegler contributed equally to this article. References 1. Pozo LBowling JPerrett CMBull RDiaz-Cano SJ Dermoscopy of trichostasis spinulosa. Arch Dermatol 2008;144 (8) 1088PubMedGoogle Scholar 2. Strobos MAJonkman MF Trichostasis spinulosa: itchy follicular papules in young adults. Int J Dermatol 2002;41 (10) 643- 646PubMedGoogle ScholarCrossref 3. Janjua SAMcKoy KCIftikhar N Trichostasis spinulosa: possible association with prolonged topical application of clobetasol propionate 0.05% cream. Int J Dermatol 2007;46 (9) 982- 985PubMedGoogle ScholarCrossref 4. Das Pinselhaar Franke F. Thysanothrix. Dermatol Wochenschr 1912;551269- 1272Google Scholar 5. Noble G Trichostasis spinulosa. Arch Dermatol Syphilol 1913;114 (5) 611- 627Google Scholar 6. Tsuboi RArano ONishikawa TYamada HKatsuoka K Randomized clinical trial comparing 5% and 1% topical minoxidil for the treatment of androgenetic alopecia in Japanese men. J Dermatol 2009;36 (8) 437- 446PubMedGoogle ScholarCrossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Dec 20, 2010

Keywords: minoxidil,terminal hair

References