What are the other Names for this Condition? (Also known as/Synonyms)

• Tricholemmoma

What is Trichilemmoma? (Definition/Background Information)

• Trichilemmoma is a benign, slow-growing tumor of the hair follicles on skin. It is typically observed in adults
• It is an uncommon tumor that occurs on the skin as a painless nodule, usually in the head and neck region
• The cause of Trichilemmoma is unknown, but the presence of multiple tumors is linked to Cowden syndrome (a genetic disorder)
• In a majority of cases, no treatment in necessary, unless it causes worrisome symptoms or cosmetic concerns in the individual. In such cases, a simple surgical excision of the tumor is considered curative
• The prognosis for Trichilemmoma is excellent with suitable treatment. However, if it is associated with Cowden syndrome, then the prognosis is dependent upon the severity of this genetic disorder

Who gets Trichilemmoma? (Age and Sex Distribution)

• Trichilemmoma may occur at any age, but is more common in adults
• Both males and females may be affected with equal frequency
• There is no predilection and all races and ethnic groups may be affected

What are the Risk Factors for Trichilemmoma? (Predisposing Factors)

• The presence of multiple Trichilemmoma tumors is associated with Cowden syndrome, a rare, genetically inherited disorder

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Trichilemmoma? (Etiology)

• The cause of development of Trichilemmoma is presently unknown
• The presence of multiple tumors, which is often associated with Cowden syndrome, indicates a genetic causative component
• Research is currently being undertaken to identify the relevant causal factors

What are the Signs and Symptoms of Trichilemmoma?

Trichilemmomas are typically asymptomatic, but the following observations may be noted:

• It usually occurs as a single, raised nodule on the skin, when they are not part of Cowden syndrome
• Multiple tumors are associated with the Cowden syndrome, a genetic condition resulting in the formation of multiple hamartomas (tumor-like benign malformations)
• Trichilemmoma is a slow-growing tumor that can range in size from a few millimeters to a centimeter. However, these nodules can grow to larger sizes too
• The skin over the nodules may have a reddish discoloration
• The nodule is usually painless and non-itchy. They are mostly well-demarcated and firm to touch
• These nodules can occur all over the body, but they are commonly observed in the head and neck region (especially in the face)
• Trichilemmomas can be sometimes confused with basal cell carcinomas

Apart from this, the signs and symptoms of Cowden syndrome (if present) may be noted.

How is Trichilemmoma Diagnosed?

A diagnosis of Trichilemmoma may involve the following:

• A thorough medical history and physical examination
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
• Differential diagnosis of other tumors, such as basal cell carcinoma, should be ruled out; hence, biopsy is an important diagnostic tool

Note: In case many tumors are present on the body, then specific tests and procedures for Cowden syndrome must be undertaken.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Trichilemmoma?

Trichilemmoma is an uncommon tumor and it does not cause any significant complications.

• However, some individuals may have concerns regarding their cosmetic appearance
• There may be complications that arise from the underlying Cowden syndrome

How is Trichilemmoma Treated?

The treatment of Trichilemmoma may involve the following:

• In a majority of cases, removal of the tumor is not necessary, unless it causes bothersome signs and symptoms such as cosmetic issues
• The treatment is a complete surgical excision, which results in a cure
• Once the nodule is completely removed, it usually does not recur. An incomplete removal may result in its recurrence
• Treatment of underlying Cowden syndrome (if present)
• Vaporization (burning-off) of the nodule can be performed using a CO2 laser

How can Trichilemmoma be Prevented?

Currently, there are no known methods to prevent Trichilemmoma occurrence.

• If there is a family history of Cowden syndrome, then genetic testing of the expecting parents (and related family members) and prenatal diagnosis (molecular testing of the fetus during pregnancy) may help in understanding the risks better during pregnancy
• In such cases, genetic counseling will help assess risks, before planning for a child

Active research is currently being performed to explore the possibilities for treatment and prevention of inherited and acquired genetic disorders.

What is the Prognosis of Trichilemmoma? (Outcomes/Resolutions)

• The prognosis for Trichilemmoma is excellent with appropriate treatment, since it is a benign tumor
• The overall prognosis may be dependent upon the underlying Cowden syndrome, if present

Additional and Relevant Useful Information for Trichilemmoma:

• There is no evidence to prove that Trichilemmoma formation is influenced by one’s dietary choices
• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse