Trichostasis spinulosa

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Trichostasis spinulosa is a common but often undiagnosed skin problem that affects hair follicles. It looks like blackheads, but the follicle is filled with a cluster of fine, short hairs and skin cells. It can appear as open blackheads, small raised bumps, or sometimes be invisible. It usually shows up on the face, especially the cheeks and nose.

The exact cause isn’t known. Possible factors include inherited hair follicle problems, dust, oils, sun exposure, heat, and allergens. One idea is that thickened skin inside the hair follicle traps hairs, so they don’t shed normally.

Diagnosis is usually made with a simple, noninvasive test called a standard skin surface biopsy.

Conditions that can look similar include Favre-Racouchot syndrome, eruptive vellus hair cysts, keratosis pilaris, and acne with comedones.

Treatments that have been tried include removing the plugs with hydroactive adhesive tapes, topical keratolytics, and retinoids (taken by mouth or applied to the skin). Repeated capryloyl salicylic acid peels have shown positive results in some people.