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INTRODUCTION Trichofolliculoma is an uncommon hamartoma of hair follicle tissue typically occurring on the face of adults. They are not associated with systemic disease or with other skin disorders. Trichofolliculomas are believed to represent abortive differentiation of pluripotent skin cells on their way to develop into hair follicles. They are associated with minimal clinical morbidity. There is no sexual or racial predilection.

CLINICAL PRESENTATION Trichofolliculoma presents as a solitary, small, dome-shaped, flesh-colored papule or nodule with a diagnostic central keratin filled pore. Telangiectatic vessels may be apparent on the surface. If the lesion is actively trichogenic, tiny tufts or wisps of white cottony hairs may protrude from the central core. In the absence of such hairs, these lesions appear more like a nodular basal cell carcinoma or nevus."

Cores White Hair Follicle
(Courtesy of Robert A. Goldberg, M.D.)

HISTOPATHOLOGY Trichofolliculomas have a dilated hair follicle, containing keratinous debris and hair shaft fragments, from which radiate numerous small follicles that exhibit variable degrees of maturation (shown below). The follicles that radiate from the central follicle may branch further to give rise to secondary or tertiary follicles. The radiating follicles may contain hair shafts, rudimentary pilar structures, or there may be only cords of epithelial cells.

Epidermal Inclusion Cyst Histopathology

DIFFERENTIAL DIAGNOSIS The differential diagnosis includes basal cell carcinoma, pilar cyst, epidermal inclusion cyst, nevus, and trichopithelioma.

TREATMENT The lesion has no malignant potential and is cured by simple surgical excision. Recurrence is rare.

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Hair Loss Prevention

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