Eruptive Vellus Hair Cysts in a 4-year-Old Black Girl

Asymptomatic flesh-colored papules were noted on the chest of a healthy 4-year-old black girl. Some of the 1- to 2-mm papules had central, comedo-like crusts. The remainder of the skin was normal.

Drs Yelva Lynfield of Cedarhurst, NY, and Alyson Penstein of New York City made the diagnosis of eruptive vellus hair cysts.

Pictured here is a classic presentation of the condition, which usually arises on the chest (but may occur elsewhere) of children and young adults. Acne, which does not occur in healthy, 4-year-old children, was excluded from the differential. Furthermore, acne lesions generally involve the face and include easily expressible comedones.

The clinical diagnosis can be confirmed by a biopsy of material from a lesion; histopathological examination will reveal a tiny pilosebaceous cyst. The lesions are caused by a developmental abnormality of vellus hair follicles that predisposes them to occlusion.

Reassurance is the only treatment necessary. The lesions involute spontaneously in a few months or years.