Pigmented follicular cyst rather than solitary vellus hair cyst

Conflict of interest: none declared. In response to the clinicopathological case by Arun et al.1 of ‘a papule with bluish ring on the chest’, we challenge their diagnosis of solitary vellus hair cyst and suggest that this is a pigmented follicular cyst. We saw a similar condition occurring in a 52‐year‐old man who presented to our pigmented lesion clinic with a 5‐year history of an unchanging pigmented lesion on the chest. On physical examination, a dark‐bluish, ring‐shaped papule, 8 mm in diameter, was seen on the anterior chest, with follicular openings centrally (Fig. 1a). Under the assumption of a cystic lesion, we incised the edge with a 7G needle (Fig. 1b). Thick coils of pigmented terminal hair were evacuated from the cyst (Fig. 1c), which is consistent with a pigmented follicular cyst. Pigmented follicular cysts are very rare and were first reported by Mehregan and Medenica in 1982.2 In that report, a series of 7 cases out of 120 000 consecutive skin biopsies were described. Since then, very few cases have been reported in the English literature. Histologically the features of a pigmented follicular cyst are of an intradermal cyst with a pore‐like opening onto the surface. The cyst is lined by stratified squamous epithelium with epidermal keratinization, and may show rete ridges and dermal papillae. There are multiple pigmented terminal shafts within the cyst along with laminated keratin.