A 48-year-old man presents for treatment of herpes zoster. As an incidental finding, numerous flesh-colored, asymptomatic papules are noted on the central face. The patient states that these have been present for several decades.
Key point: The clinical picture and history is consistent with hereditary trichoepithelioma, a benign dermal skin tumor derived from immature hair follicle cells. While unsightly, these tumors have no malignant potential and no serious systemic associations. This is an autosomal dominant condition.
Treatment: While treatment is not medically necessary, cosmetically objectionable lesions can be removed by electrodesiccation or via carbon dioxide laser ablation. The risk of scar formation must be considered and discussed before embarking on a program of lesion destruction.
Note: These lesions must be differentiated from facial angiofibromas (associated with tuberous sclerosis), which appear in the same central facial region. The angiofibromas tend to be smaller, even more numerous, and more erythematous.