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Trichilemmal cyst
Classification and external resources

Trichilemmal Cyst - Note the thick durable white shell.
ICD-10 L72.1
ICD-O: 8103/0
DiseasesDB 29388

A trichilemmal cyst (also known as a "Pilar cyst" and "Isthmus-catagen cyst"[1]:779[2]:677) is a common fluid-filled growth (cyst) that forms from a hair follicle. They are most often found on the scalp. The cysts are smooth and mobile, filled with keratin (a protein component found in hair, nails, and skin), and they may or may not be tender. Pilar cysts may run in families. Rarely, these cysts may grow more extensively and form rapidly multiplying (proliferating) pilar tumors (also called proliferating trichilemmal cysts), which are non-cancerous (benign) but may grow aggressively at the cyst site. Very rarely, pilar cysts can become cancerous.[3]

Contents

Cause

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Pathophysiology

Trichilemmal cysts are derived from the outer root sheath of the hair follicle. Their origin is unknown, but it has been suggested that they are produced by budding from the external root sheath as a genetically determined structural aberration. They arise preferentially in areas of high hair follicle concentrations, therefore, 90% of cases occur on the scalp. They are solitary in 30% of cases and multiple in 70% of cases.[4]

Histologically, areas with signs of proliferation can be found in some cysts. In rare cases, this leads to formation of a tumor, known as a proliferating trichilemmal cyst. The tumor is clinically benign, although it may display nuclear atypia, dyskeratotic cells, and mitotic figures. These features can be misleading, and a diagnosis of squamous cell carcinoma may be mistakenly rendered.

Treatment

Surgical excision is required. The method of treatment varies depending on the physician's training. Most physicians perform the procedure under local anesthetic. Some excise the entire tumor intact with an elliptical excision. This often leaves a sizable scar and significant bleeding due to the necessity to cut into the subcutaneous tissue. Others prefer the conservative approach, which has very little complications. The conservative approach involves the use of a small punch biopsy about 1/4 the diameter of the cyst. The punch biopsy is used to enter the cyst cavity. The content of the cyst is emptied, leaving an empty sac. As the pilar cyst wall is the thickest and most durable of the many varieties of cysts, it can be grabbed with forceps and pulled out of the small incision. This method is best performed on cysts larger than a pea which have formed a thick enough wall to be easily identified after the sac is emptied. Small cysts have walls which are thin, and easily fragmented on traction. This will result in recurrence of the cyst. The conservative method often results in only a small scar, and very little if any bleeding.

See also

References

  1. ^ Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0071380760.
  2. ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0721629210.
  3. ^ http://www.visualdxhealth.com/adult/pilarCyst.htm
  4. ^ http://www.emedicine.com/DERM/topic328.htm

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