Letters to Editor
Trichilemmal cysts are almost always benign, although malignant transformation can be seen in 2% cases. It is a spectrum of transformation from benign pilar cyst to a proliferating tumor to malignant proliferating trichilemmal tumor. Histopathologically, the cyst contains homogeneous eosinophilic keratinous material. Foci of calcification may develop. The cell of the lining epithelium gradually increases in size as they approach the cyst cavity, appearing swollen with pale cytoplasm, keratinizing abruptly. It is differentiated from epidermoid cyst by absence of punctum and location. Wide excision is the treatment of choice but recurrences are common.[5] Knowledge about morphology of different cystic lesion and its behavior is essential to come to diagnosis. Many benign cystic lesions can have unusual presentation and can be clinically misdiagnosed. This case not only highlights the unusual location of trichilemmal cyst but also the importance of doing histopathological examination to come to accurate diagnosis.
Address for correspondence: Dr. Sahana M Srinivas, Consultant Dermatologist, Ananya Hospital, Bangalore, Karnataka ‑ 560 010, India. E‑mail: [email protected] REFERENCES 1.
McGavran MH, Binnington B. Keratinous cysts of the skin. Identification and differentiation of pilar cysts from epidermal cysts. Arch Dermatol 1966;94:499‑508. 2. Adya KA, Inamdar AC, Palit A. Multiple firm mobile swellings over the scalp. Int J Trichology 2012;4:98‑9. 3. Ikegami T, Kameyama M, Orikasa H, Yamazaki K. Trichilemmal cyst in the pulp of the index finger: A case report. Hand Surg 2003;8: 253‑5. 4. Sadath HN, Ramachandra S, Kumar MA, Haritha K. Multicentric calcified trichilemmal cysts with alopecia universalis affecting siblings. Indian J Dermatol Venereol Leprol 2013;79:88‑91. 5. Anolik R, Firoz B, Walters RF, Meehan SA, Tsou HC, Whitlow M, et al. Proliferating trichilemmal cyst with focal calcification. Dermatol Online J 2008;14:25. Access this article online Quick Response Code
Sahana M Srinivas, Chavan R Vittal1, Madhavi Naik2, Chethan Nagaraj3 Departments of Dermatology, 1Surgery, 3Orthopaedics, Ananya Hospital, 2Department of Pathology, St Theresa’s Hospital, Bangalore, Karnataka, India
Website: www.ijtrichology.com
DOI: 10.4103/0974-7753.125623
Alopecia Universalis in Polyglandular Autoimmune Syndrome Type I Sir, A 48‑year‑old married woman presented with nausea, vomiting, abdominal pain and generalized weakness. She also complained of skin pigmentation and whitish lesions in the oral cavity since 2 months for which she was referred to our department. She was a known case of diabetes mellitus type 1, on medications and had generalized hair loss since 15 years. There was no history of seizures, dental dystrophy, keratopathy and dystrophy of nails. There were no similar complaints in other family members. Dermatological examination revealed dry skin with increased facial pigmentation. There was absence of hair over the scalp, eyebrows, eyelashes, armpits and suprapubic region [Figures 1 and 2]. Oral examination 164
revealed a curdy white plaque with a pseudomembrane over the tongue and buccal mucosa (suggestive of candidiasis). General and systemic examination showed no abnormality. Further enquiry and examination of her medical records revealed, she was a known case of polyglandular autoimmune syndrome‑1 (PGA‑1) with features of Addison’s disease, hypoparathyrodism and type 1 diabetes mellitus. Complete hemogram was within the normal limits. Blood sugar fasting level was 220 mg/dL and postprandial was 285 mg/dL. Tests for Serum calcium and phosphorus showed a value of 7 mg/dL and 13 mg/dL respectively. Level of ionized calcium was also reduced to 1 mmol/L. An International Journal of Trichology / Jul-Sep 2013 / Vol-5 / Issue-3
Letters to Editor
Figure 1: Facial pigmentation and absence of hair over eyebrows
Figure 2: Absence of hair over the scalp
8 am plasma cortisol level was
Trichilemmal cysts are almost always benign, although malignant transformation can be seen in 2% cases. It is a spectrum of transformation from benign pilar cyst to a proliferating tumor to malignant proliferating trichilemmal tumor. Histopathologically, the cyst contains homogeneous eosinophilic keratinous material. Foci of calcification may develop. The cell of the lining epithelium gradually increases in size as they approach the cyst cavity, appearing swollen with pale cytoplasm, keratinizing abruptly. It is differentiated from epidermoid cyst by absence of punctum and location. Wide excision is the treatment of choice but recurrences are common.[5] Knowledge about morphology of different cystic lesion and its behavior is essential to come to diagnosis. Many benign cystic lesions can have unusual presentation and can be clinically misdiagnosed. This case not only highlights the unusual location of trichilemmal cyst but also the importance of doing histopathological examination to come to accurate diagnosis.
Address for correspondence: Dr. Sahana M Srinivas, Consultant Dermatologist, Ananya Hospital, Bangalore, Karnataka ‑ 560 010, India. E‑mail: [email protected] REFERENCES 1.
McGavran MH, Binnington B. Keratinous cysts of the skin. Identification and differentiation of pilar cysts from epidermal cysts. Arch Dermatol 1966;94:499‑508. 2. Adya KA, Inamdar AC, Palit A. Multiple firm mobile swellings over the scalp. Int J Trichology 2012;4:98‑9. 3. Ikegami T, Kameyama M, Orikasa H, Yamazaki K. Trichilemmal cyst in the pulp of the index finger: A case report. Hand Surg 2003;8: 253‑5. 4. Sadath HN, Ramachandra S, Kumar MA, Haritha K. Multicentric calcified trichilemmal cysts with alopecia universalis affecting siblings. Indian J Dermatol Venereol Leprol 2013;79:88‑91. 5. Anolik R, Firoz B, Walters RF, Meehan SA, Tsou HC, Whitlow M, et al. Proliferating trichilemmal cyst with focal calcification. Dermatol Online J 2008;14:25. Access this article online Quick Response Code
Sahana M Srinivas, Chavan R Vittal1, Madhavi Naik2, Chethan Nagaraj3 Departments of Dermatology, 1Surgery, 3Orthopaedics, Ananya Hospital, 2Department of Pathology, St Theresa’s Hospital, Bangalore, Karnataka, India
Website: www.ijtrichology.com
DOI: 10.4103/0974-7753.125623
Alopecia Universalis in Polyglandular Autoimmune Syndrome Type I Sir, A 48‑year‑old married woman presented with nausea, vomiting, abdominal pain and generalized weakness. She also complained of skin pigmentation and whitish lesions in the oral cavity since 2 months for which she was referred to our department. She was a known case of diabetes mellitus type 1, on medications and had generalized hair loss since 15 years. There was no history of seizures, dental dystrophy, keratopathy and dystrophy of nails. There were no similar complaints in other family members. Dermatological examination revealed dry skin with increased facial pigmentation. There was absence of hair over the scalp, eyebrows, eyelashes, armpits and suprapubic region [Figures 1 and 2]. Oral examination 164
revealed a curdy white plaque with a pseudomembrane over the tongue and buccal mucosa (suggestive of candidiasis). General and systemic examination showed no abnormality. Further enquiry and examination of her medical records revealed, she was a known case of polyglandular autoimmune syndrome‑1 (PGA‑1) with features of Addison’s disease, hypoparathyrodism and type 1 diabetes mellitus. Complete hemogram was within the normal limits. Blood sugar fasting level was 220 mg/dL and postprandial was 285 mg/dL. Tests for Serum calcium and phosphorus showed a value of 7 mg/dL and 13 mg/dL respectively. Level of ionized calcium was also reduced to 1 mmol/L. An International Journal of Trichology / Jul-Sep 2013 / Vol-5 / Issue-3
Letters to Editor
Figure 1: Facial pigmentation and absence of hair over eyebrows
Figure 2: Absence of hair over the scalp
8 am plasma cortisol level was
