Eruptive Vellus Hair Cysts Treatment & Management

Updated: Jul 29, 2019
  • Author: Stephanie Juliet Campbell, DO; Chief Editor: Dirk M Elston, MD  more...
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Medical Care

Twenty-five percent of eruptive vellus hair cyst (EVHC) cases resolve spontaneously through transepidermal elimination.

Keratolytic treatment was reported as beneficial after gentle mechanical dermabrasion with an exfoliating sponge (eg, Buf Puf, 3M; St. Paul, Minn) followed by an application of 10% urea cream. Significant clinical improvement resulted in one case with 12% lactic acid applied to the affected areas.

Retinoid treatment can be helpful. Topical tretinoin applied nightly to the affected area is a reasonably safe treatment option. This method reportedly cleared a case of congenital EVHC after only 5 applications, leaving only a slight residual erythema that gradually faded. Topical tazarotene cream 0.1% applied to the affected area was shown to be more effective than some surgical options for the treatment of EVHC. [33]  Oral isotretinoin at 1 mg/kg/d produced no improvement in one patient after 20 weeks of therapy. [34]  Systemic vitamin A therapy (100,000 IU/d) has also been tried; however, this also produced no clinical improvement and resulted in severe headaches requiring discontinuation of therapy.

Calcipotriene treatment has been reported. A single case report showed a partial response of EVHCs after a 2 months treatment course with topical calcipotriene. [35]


Surgical Care

Needle evacuation of eruptive vellus hair cysts (EVHCs) can be performed using an 18-gauge needle after local anesthesia with a topical anesthetic (EMLA cream). [36] This technique can also be used to aid in the diagnosis of EVHC. After extrusion, the cyst is examined histologically, pressed between a glass slide and cover slip with mineral oil. Multiple thin, fine hairs can be seen within the lumen of the thin cyst wall.

Simple excision (eg, punch biopsy technique) removes the cyst; however, this is not practical for most cases of EVHCs because the cysts are too numerous and punch biopsy scars may be unsightly.

Carbon dioxide laser vaporization has been effective for a case of EVHC on the face. [37] A test spot was performed with the carbon dioxide laser (10,600-nm wavelength) at 5 watts of power, irradiance of 160 W/cm2, a 2-mm spot size, and a pulse duration of 0.2 seconds. No scarring occurred after treating the face in the same manner. Eyelid lesions were treated in the same manner except they used only 3 watts of power and 100 W/cm2 irradiance. Slight hyperpigmentation occurred at some of the treated sites; no hypertrophic scarring was noted. Cystic regeneration did not occur.

Pulsed erbium:yttrium-aluminum-garnet (Er:YAG) laser has been reported effective in treating 2 patients with EVHCs on the trunk. [38] The technique involved drilling with the Er:YAG laser (2940-nm wavelength) using a 2-mm spot size, 250-microsecond pulse duration at 60.5-63.7 J/cm2, and a 1.9- to 2-J pulse energy. Three to 5 stacked pulses were delivered, the cysts were expressed with digital pressure, they were extracted with forceps, the base of the cyst wall was further ablated with 3 pulses, and the area was allowed to heal by secondary intention. The follow-up evaluation was performed only by telephone interview; patients reported no scarring, discoloration, or recurrence of the cysts. However, another report has suggested early recurrence of the cysts after treatment with Er:YAG laser to EVHC on the face. [39]

A split face study compared the 2940 nm Er:YAG laser with a nonablative 1540 Er:Glass laser. The treatment period was 9 months, with treatment intervals of 6-12 weeks. The study found a reduction in total number of cysts with a tendency for better clinical outcome using the Er:YAG ablative laser. [40]