trichofolliculoma although classified under hair follicle tumors , essentially are benign hamartomas of the hair follicle . they are rare and usually present as solitary lesions on the face often with a tiny tuft of fine white hairs arising from the surface . a 21-year - old male presented with multiple asymptomatic skin colored raised lesions on the face of 13 years duration . clinical examination revealed multiple non - tender skin colored papules on the forehead , cheeks , nose , naso - labial folds and chin [ figure 1 ] . multiple trichofolliculomas on the face haematoxylin and eosin stained sections showed a dermal keratin cyst lined by squamous epithelium . the adjacent dermis showed pilosebaceous units and a partially ruptured hair follicle eliciting a giant cell response [ figures 2 and 3 ] . on the basis of the histopathological features , a final diagnosis of trichofolliculomas was made . dermal keratin cyst with secondary hair follicles ( h and e , 5 ) secondary hair follicle from keratin cyst wall ( h and e , 20 ) trichofolliculoma first described by miescher . is a rare hair follicle tumor that manifests as a solitary skin colored papule or nodule often with a central pore . the characteristic feature is the tuft of fine white hair that projects from the pore . multiple trichofolliculomas are rare and have been reported on the upper extremities , scrotum and penis , and a patient with only two trichofolliculomas on ears with generalized multiple trichogenic myxomas . the presence of vellus hairs in a tuft like pattern arising from the lesion is considered to a distinctive feature of trichofolliculoma . however , trichofolliculomas undergo evolution during the course and thus , manifests with varying clinical and histopathological morphologies . another useful aid to the diagnosis of trichofolliculoma is dermascopy showing peripheral radial dark brown projections resembling a crown and described as the characteristic histopathological features of trichofolliculoma include a squamous epithelium lined keratin containing dermal cyst with radiating hair follicles from the cyst wall . these secondary hair follicles are interconnected with each other by epithelial strands in all cases . cohesive and branching clusters of keratinized squamous cells mixed with sebaceous cells are seen in fine needle aspiration cytology of trichofolliculoma . two variants of trichofolliculomas include sebaceous trichofolliculoma and folliculosebaceous cystic hamartoma that may represent an evolutionary stage . even though trichofolliculomas are considered to be benign , perineural invasion has been described in a patient as well as recurrence following excision . our patient presented with multiple skin colored papules resembling trichoepitheliomas and it was only the biopsy which confirmed the diagnosis of trichofolliculoma . in view of the long standing duration of the lesions , the classical picture of vellus hairs protruding from the nodule was not seen . our case was very similar to the previously reported case of multiple trichofolliculomas with numerous 0.3 to 1.5 cm sized papules and nodules without any vellus hairs . our initial diagnosis was multiple trichoepitheliomas in view of the childhood onset ; positive family history and clustering of lesions in the nasolabial folds but the characteristic histological features such as horn cysts and basaloid epithelial islands in the dermis were absent . we report this case for its rarity of occurrence , onset in childhood , presence of family history of similar lesions , the clinical resemblance to trichoepitheliomas and the absence of clinically demonstrable vellus hairs .
trichofolliculomas are benign hair follicle hamartomas which were initially considered as hair follicle tumors . 
 usually presenting as a solitary lesion associated with a tuft of vellus hairs , multiple trichofolliculomas are rare . 
 trichofolliculomas are characterized by a histopathological feature of dermal keratin cyst with cyst wall showing radiating hair follicles . 
 we report this case for the rare presentation of multiple trichofolliculomas on the face which clinically mimicked multiple trichoepitheliomas .