Solitary Papule with Central Crater in a Young Man: Dermoscopy Picks the Clue

A 26-year-old male presented with an asymptomatic papule on his right cheek that had been gradually increasing for a year. Dermoscopy revealed a light-pink background, central white scales, follicular plugging, and a small cluster of short fine nonpigmented hairs. The lesion was excised and histopathological analysis revealed it to be a trichofolliculoma, an uncommon benign hair follicle hamartoma. Trichofolliculoma is typically seen in young individuals and usually presents as a solitary asymptomatic skin-colored to erythematous papule or nodule with a central pore draining sebum and keratinous debris or exhibiting a tuft of vellus hairs. The clinical course of trichofolliculoma is benign and treatment is usually for cosmetic concerns only. Malignant transformation is exceedingly rare. The excision of the lesion in this case was curative. Dermoscopy appears very useful in the diagnosis of trichofolliculoma when it can visualize the central tuft of hair in cases where the same is not evident clinically.