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TRICHOSTASIS SPINULOSA (TS) is a relatively common but underdiagnosed disorder of hair follicles that retain successive telogen hairs. It has been described within skin lesions (secondary TS) or as an isolated finding (primary TS). Dermoscopy may help identify the characteristic hair tuft. We report 2 cases of TS. The first case involved a 23-year-old woman who presented with a long-standing history of a light-brown papule on the lower part of her back. There was a black punctum in the upper central area of the lesion (Figure 1). Dermoscopy showed a sparse pigment network, multiple commalike blood vessels that are typical of intradermal melanocytic nevi, a few peripheral vellous hairs, and a small hair tuft emerging from the central punctum (Figure 2). Histologic examination confirmed the presence of an intradermal melanocytic nevus along with dilated folliculosebaceous bunits containing several cross-sectioned hair shafts (Figure 3). The second case involved a 30-yearold man who presented with a micropapular eruption on both flanks. Dermoscopy showed multiple vellous hairs erupting through the follicles (Figure 4). Hair tufts are the result of folliculosebaceous hamartomas with multiple units around a central pore (trichofolliculomas) or retained hair shafts within follicles with infundibular keratosis (TS). Trichostasis spinulosa may appear as an isolated finding or in association with expansile nondestructive lesions that narrow hair infundibulae, such as melanocytic nevi, seborrheic keratoses, syringomas, or nodular basal cell carcinomas. Dermoscopy is helpful in diagnosing TS.

REPORT OF A CASE A 34-year-old woman presented with a 10-year history of pruritic black papules on her face. Her medical history was unremarkable. Her physical examination showed numerous open comedolike lesions distributed over the glabella, nose, cheeks, and chin ( Figure 1 ). Some of these lesions were excoriated and on closer examination were noted to be dilated follicles containing tufts of hairs. The findings of the remainder of her physical examination were unremarkable. Keratinaceous debris and vellus hairs from several follicles were removed by a hair pull and examined under the microscope. ( Figure 2 ). What is your diagnosis? DIAGNOSIS: Trichostasis spinulosa. DISCUSSION Trichostasis spinulosa is an underrecognized yet common condition. It is characterized clinically by follicular keratotic plugs in which multiple vellus hairs are embedded. The lesions usually present as pruritic, hyperkeratotic papules. The disease can affect all age groups and both sexes; it commonly develops develops in elderly persons who have suffered long-term sun damage. Patients

To the Editor.— Monilethrix is a dysplasia of the hair shaft; it is characterized by eliptical nodes separated by constricted internodes at which the medulla is lacking. The disease is uncommon; its mechanism of production is unknown; and up until the present, to our knowledge, no effective treatment had been known. In the last few years, tretinoin has become a common therapeutic modality. Its effectiveness has been proved in the treatment of a variety of different conditions such as acne comedonicus, 1 pseudoacanthosis nigricans, 2 Darier disease, 3 nevus comedonicus, 4 senile comedones, 5 trichostasis spinulosa, 6 steroid-induced acne 7 and in several kinds of icthiosis. 8 Other conditions for which tretinoin therapy has been used include psoriasis, 9 lichen planus, 10 and keratodermia 11 ; the effectiveness of tretinoin therapy in these cases must still be determined. Recently, we saw a patient with monilethrix, and we would like to report

The first recorded observation found in the literature of this interesting and apparently rare disorder is that of Galewsky. 1 The case occurred in a man whose age is not given and whose case was demonstrated before a meeting of the Deutscher Naturforscher und Arzte of Dresden, in 1907. The patient consulted Galewsky for a pustular folliculitis and was entirely unaware of the presence of an area of alopecia on the otherwise unusually hairy abdomen. In this area, which is described as being two and one-half times the size of an orange, the follicles contained blackish, elevated, horny, spinous plugs which filled the dilated orifices, and which could be easily removed. When examined microscopically, the keratotic masses were found to contain bundles of lanugo hairs which protruded beyond the keratotic plugs. There was no subjective sensation, and the patient did not return for further observation. It was not until 1911

Trichostasis spinulosa consists of fascicles of retained hairs in hyperkeratotic sebaceous follicles resulting in dark plugs predominantly on the nose. The condition is very common particularly among the aged, and is ordinarily not recognized by dermatologists. Daily topical application of a 0.05% solution of tretinoin will expell the hair plugs and eradicate the manifestations of the disorder.