There are many different types of abnormal growths that can arise on the skin. Most of us think of it simply as a pimple, wart or mole. However, there are several different ways in which the skin may be diseased or abnormal thereby leading to the formation of a growth. One rare type of growth is a folliculoma. It is not a serious skin condition and usually does not cause symptoms. However, the choice to remove it is mainly for cosmetic reasons.
What is a folliculoma?
A folliculoma, also known as a trichofolliculoma, is a rare benign tumor of the hair follicle. Typically it occurs on the face of adults but may also occur on the scalp, neck or ears. Folliculomas are largely asymptomatic but the presence of this tumor usually prompts patients to seek treatment for cosmetic reasons. It is easily treated although treatment is not necessary. Folliculomas mainly affect males. It tends to appear in the late teens or sometimes as late as by the fourth decade of life.
The word tumor is often considered in a serious manner and tends to cause concern. However, it simply refers to abnormal or excessive tissue growth or some other type of mass. Most of the time these masses are not serious. A benign tumor simply means that there is excess cells but the cells are not usually abnormal in structure and do not invade healthy tissue as is the case with cancer. However, with the risk of skin cancer it is always advisable to have any skin lump checked by a medical professional to exclude a possible malignant (cancerous) growth.
Causes of Folliculoma
The exact cause of a folliculoma is unknown but it appears to be due to abnormal development of the hair follicles. However, it only appears later in life. A few cases have been observed from birth but this is very uncommon. Folliculomas are benign tumors, meaning that it is non-cancerous. These types of growths are known as hamartomas. The nodules that appear on the skin are sometimes mistaken by for possible cancerous lesions of the skin, like basal cell carcinoma. It is therefore important that the lesions are inspected by a medical professional.
A folliculoma develops spontaneously but in rare instances there may be some history of trauma at the site. Even though the follicle may have developed abnormally, a strand of hair or several strands may protrude through the surface of some lumps. This is sometimes mistaken for an ingrown hair. The central pore on lump leads to a cavity in the deeper layer of the skin (dermis). While some may have strands or tufts of hair others may only produce tiny fragments of skin protein (keratin).
Although research on folliculomas is limited, it has found to be more common among Caucasians in a study done on military personnel. Genetic factors have not been identified as a possible cause.
Signs and Symptoms
Most of the time a folliculoma presents as a single isolated nodule which is flesh-colored or whitish in color. It usually appears on the face, scalp, ears, neck and has even been known to occur on the vulva in women. A common site for a folliculoma is around the nose area. The lumps grow slowly and are usually around 0.2 to 1cm in diameter (about a half inch in diameter). Most lumps have a central hole (pore). Tiny hairs may be noticed in this central pore which may protrude from the surface. However, this is not always present and it is not uncommon for people to think that it is a pimple, wart or mole.
Folliculomas are usually asymptomatic. There is no pain, redness or itching. Normal hair follicles undergo different stages of hair growth as characterized by the three stages known as the anagen, catagen and telogen phases. Although the hair follicle may be abnormal in a folliculoma there may certain changes that occur in it corresponding to these different phases. Tufts of hair may sometimes be visible through the pores but it does not usually grow as would be expected from a normal hair follicle.
Repeated picking or pinching of a lesion can cause localized inflammation and increase the risk of a superficial infection. Pain, redness and swelling around the lesion may be indicative of an infection. This can confuse the diagnosis at times.
It is important to note that these masses may appear similar to other types of skin lesions. The presence of a hair in the central pore is usually conclusive for a folliculoma but this is not always present. Other conditions which may be suspected includes milia, basal cell carcinoma, molluscum contagiosum and nevi (moles).
Treatment of Folliculoma
Folliculomas are non-cancerous (benign) and asymptomatic. It therefore poses no threat to the patient and does not cause any discomfort. However, a person may opt to remove it and this is usually for cosmetic reasons. There is no medical treatment such as ointments or creams and a folliculoma has to be surgically removed. The growth is excised (“cut off”) and will not regrow if it is removed completely. Lasers have also been successfully used to remove it. However, incomplete removal can result in it recurrence.
Although a folliculoma is not serious and can be completely removed it should only be removed by a medical professional. Complications can arise if the removal is done improperly, such as infections of the skin and scarring. Always consult with a dermatologist. To the untrained eye a folliculoma can be mistaken for other conditions and vice versa. If the mass cannot be conclusively identified as a folliculoma by physical inspection then it may be examined microscopically.
Folliculomas do not usually require long term monitoring. It does not have any malignant potential meaning that it cannot become cancerous. It is completely benign (non-cancerous). Recurrence of the lesion does not indicate malignancy but occurs if it was not completely removed. However, it is important that lesions are identified as folliculomas by a medical professional in order to exclude more serious pathology like basal cell carcinoma.