Do These Multiple Asymptomatic Lesions on a Boy’s Chest Require Treatment?

Case:

The lesions on this 10-year-old boy had developed during the past year. They were asymptomatic and appeared only on the anterior chest. The child's older brother had had similar lesions, also on the chest, for more than 10 years. The boys' mother was concerned that her younger son might experience the same "disfigurement" as her older son and wanted to prevent that from happening.

What can you tell the mother about her child's lesions and their treatment?

Answer on Next Page

Eruptive vellus hair cysts may resolve spontaneously; treatment requires destruction of the cysts

When vellus hair cysts are multiple, they are termed "eruptive." The lesions may be inherited in an autosomal dominant pattern. The cysts are the result of a defect in a keratin gene, which causes occlusion of the vellus hair follicle orifice. This leads to a distal cystic dilation of the hair follicle and the retention of the vellus hairs within the cyst.

The lesions present as skin-colored to darkly pigmented papules and cysts and most commonly occur over the anterior chest or trunk. They are generally asymptomatic but may become inflamed. The onset is typically in the first decade of life. Boys and girls are affected equally.

Eruptive vellus hair cysts may resolve spontaneously with time. Treatment is unnecessary, but if desired, the physical destruction of the cyst or its complete removal is required to prevent recurrence.