Folliculoma
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Folliculoma, also known as trichofolliculoma, is a type of benign cutaneous adnexal tumor. [1] Cutaneous adnexal tumors are neoplasms that are classified based on their morphologic differentiation towards at least one type of normal skin structure: hair follicles, apocrine glands, eccrine glands, or sebaceous glands. [2, 3]
A folliculoma is a rare, asymptomatic tumor of the hair follicle. This is a hamartoma of the hair follicle, a malformation of cells and tissues that resembles a normal hair follicle. Clinically, it appears as a small, solitary, skin-colored papule or nodule on the face or scalp. A tuft of vellus hair often protrudes from a central punctum. Folliculomas usually present in middle-aged adults, but they have been found at birth and can develop throughout life.
Trichofolliculomas represent a hamartomatous, adnexal tumor originating from the hair follicle. [4] The tumor is a benign malformation of hair follicle cells and structures. All stages of follicular development can be observed in the lesion.
A variant of the trichofolliculoma is the sebaceous trichofolliculoma. Schulz and Hartschuh suggest folliculosebaceous cystic hamartoma is a folliculoma at its very late stage. [5] Cole et al suggest no pathogenetic relationship exists with giant, congenital folliculosebaceous cystic hamartomas. [6]
Folliculomas are caused by a maldevelopment of the hair follicle unit. Folliculomas undergo anatomical changes corresponding to the regressing normal hair follicle in its various cycles.
United States
Folliculomas are uncommon. Given their benign nature, no large screening has been performed in the general population. As a result, an exact incidence has not been determined.
International
The condition has been reported worldwide. It is a rare entity among all nationalities.
A study performed with military personnel demonstrated that folliculomas are more common in whites than in any other race.
Folliculomas occur predominantly in males.
The mean age of manifestation is 45 years, but lesions can be congenital or occur much later in life. [7]
The prognosis is excellent. Folliculomas are benign, asymptomatic lesions with no malignant potential.
Patients should be informed of the benign nature of these lesions and that they require no follow-up care.
Clinically, trichofolliculomas may be confused with a more serious entity, such as basal cell carcinoma. Thus, the lesion may need to be excised to confirm the diagnosis. If excision is performed for diagnostic or cosmetic purposes, recurrence can occur if the lesion is not completely removed. [8]
Ireland AM, Harvey NT, Berry BD, Wood BA. Paediatric cutaneous adnexal tumours: a study of 559 cases. Pathology. 2017 Jan. 49 (1):50-54. [Medline].
Alsaad KO, Obaidat NA, Ghazarian D. Skin adnexal neoplasms–part 1: an approach to tumours of the pilosebaceous unit. J Clin Pathol. 2007 Feb. 60 (2):129-44. [Medline]. [Full Text].
Obaidat NA, Alsaad KO, Ghazarian D. Skin adnexal neoplasms–part 2: an approach to tumours of cutaneous sweat glands. J Clin Pathol. 2007 Feb. 60 (2):145-59. [Medline].
Misago N, Ansai SI, Fukumoto T, Anan T, Kimura T, Nakao T. Chronological changes in trichofolliculoma: Folliculosebaceous cystic hamartoma is not a very-late-stage trichofolliculoma. J Dermatol. 2017 Sep. 44 (9):1050-1054. [Medline].
Schulz T, Hartschuh W. Folliculo-sebaceous cystic hamartoma is a trichofolliculoma at its very late stage. J Cutan Pathol. 1998 Aug. 25(7):354-64. [Medline].
Cole P, Kaufman Y, Dishop M, Hatef DA, Hollier L. Giant, congenital folliculosebaceous cystic hamartoma: a case against a pathogenetic relationship with trichofolliculoma. Am J Dermatopathol. 2008 Oct. 30(5):500-3. [Medline].
Romero-Pérez D, García-Bustinduy M, Cribier B. Clinicopathologic study of 90 cases of trichofolliculoma. J Eur Acad Dermatol Venereol. 2016 Sep 8. [Medline].
Morton AD, Nelson CC, Headington JT, Elner VM. Recurrent trichofolliculoma of the upper eyelid margin. Ophthal Plast Reconstr Surg. 1997 Dec. 13(4):287-8. [Medline].
Ishii N, Kawaguchi H, Takahashi K, Nakajima H. A case of congenital trichofolliculoma. J Dermatol. 1992 Mar. 19(3):195-6. [Medline].
Peterdy GA, Huettner PC, Rajaram V, Lind AC. Trichofolliculoma of the vulva associated with vulvar intraepithelial neoplasia: report of three cases and review of the literature. Int J Gynecol Pathol. 2002 Jul. 21(3):224-30. [Medline].
Jégou-Penouil MH, Bourseau-Quetier C, Cajanus S, Rigon JL, Risbourg M, Kluger N. [Trichofolliculoma: a retrospective review of 8 cases]. Ann Dermatol Venereol. 2015 Mar. 142 (3):183-8. [Medline].
Panasiti V, Roberti V, Lieto P, Visconti B, Calvieri S, Perrella E. The “firework” pattern in dermoscopy. Int J Dermatol. 2013 Sep. 52 (9):1158-9. [Medline].
Garcia-Garcia SC, Villarreal-Martinez A, Guerrero-Gonzalez GA, Miranda-Maldonado I, Ocampo-Candiani J. Dermoscopy of trichofolliculoma: a rare hair follicle hamartoma. J Eur Acad Dermatol Venereol. 2017 Feb. 31 (2):e123-e124. [Medline].
Bogle MA, Cohen PR, Tschen JA. Trichofolliculoma with incidental focal acantholytic dyskeratosis. South Med J. 2004 Aug. 97(8):773-5. [Medline].
Mizutani H, Senga K, Ueda M. Trichofolliculoma of the upper lip: report of a case. Int J Oral Maxillofac Surg. 1999 Apr. 28(2):135-6. [Medline].
Manabe M, Yaguchi H, Iqbal Butt K, O’Guin WM, Loomis CA, Sung TT, et al. Trichohyalin expression in skin tumors: retrieval of trichohyalin antigenicity in tissues by microwave irradiation. Int J Dermatol. 1996 May. 35(5):325-9. [Medline].
Hartschuh W, Schulz T. Immunohistochemical investigation of the different developmental stages of trichofolliculoma with special reference to the Merkel cell. Am J Dermatopathol. 1999 Feb. 21(1):8-15. [Medline].
Kurokawa I, Kusumoto K, Sensaki H, Shikata N, Tsubura A, Nishijima S. Trichofolliculoma: case report with immunohistochemical study of cytokeratins. Br J Dermatol. 2003 Mar. 148(3):597-8. [Medline].
Zimmermann T, Hartschuh W, Raulin C. [Facial folliculo-sebaceous cystic hamartoma. Treatment with CO2 and Er:YAG lasers]. Hautarzt. 2004 Mar. 55(3):289-91. [Medline].
Gray HR, Helwig EB. Trichofolliculoma. Arch Dermatol. 1962. 86:619-25.
Miescher G. Trichofolliculoma. Dermatologica. 1944. 89:193-194.
Kristen D Fajgenbaum University of North Carolina at Chapel Hill School of Medicine
Disclosure: Nothing to disclose.
Christopher Sayed, MD Clinical Assistant Professor of Dermatology, Clinician Educator, Director of Medical Student Education, Director of Hidradenitis Suppurativa Clinic, University of North Carolina at Chapel Hill School of Medicine
Christopher Sayed, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, Medical Dermatology Society, North Carolina Dermatology Association, Society for Investigative Dermatology, Society for Pediatric Dermatology
Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Abbvie, Inc.
Craig N Burkhart, MD, MSBS Assistant Professor, Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
Craig N Burkhart, MD, MSBS is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Medical Association
Disclosure: Nothing to disclose.
Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology
Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association
Disclosure: Nothing to disclose.
Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology
Disclosure: Received income in an amount equal to or greater than $250 from: Lilly; Amgen <br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; for: Allergen; Celgene; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen.
Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.
Craig G Burkhart, MD, MPH Clinical Professor, Department of Medicine, Medical College of Ohio; Clinical Assistant Professor, Department of Medicine, Ohio University College of Osteopathic Medicine
Craig G Burkhart, MD, MPH is a member of the following medical societies: Association of Military Dermatologists, American College of Aesthetic and Cosmetic Physicians; American Society of Aesthetic/Cosmetic Physicians, Michigan Dermatological Society, Academy of Medicine of Toledo and Lucas County, Ohio Dermatological Association, American Academy of Dermatology, Ohio State Medical Association, Phi Beta Kappa
Disclosure: Nothing to disclose.
Folliculoma
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