Case study: trichoblastoma
This article describes the case of a 62-year-old Malay woman diagnosed with extensive facial trichoblastoma, a tumour of the hair follicle, on her regular visit to the primary care clinic. The patient had been diagnosed with hypertension and diabetes mellitus several months earlier. Doctors had prescribed her perindopril, amlodipine, metformin extended-release, gliclazide modified-release and atrovastatin.
The patient did not have a history of smoking, drinking alcohol or using recreational drugs. Similarly, her family history also did not reveal anything significant except for the fact that she was diagnosed with nasal cancer at the age of 57. In addition, this was her first visit to this particular doctor.
Investigations and findings
On examination, the patient was wearing a headscarf and a face mask because of the COVID-19 pandemic. Her blood pressure 161/93 mmHg, whereas her pulse rate was 98 beats per minute. Cardiovascular examination showed no significant findings. Further examination showed numerous skin-coloured papules and nodules on the patient’s nose, nasal bridge, forehead and around the eyes. There were no signs of ulcers or telangiectasias. Further examination revealed that the lesions were non-tender, soft and had no hypoesthesia.
The patient later revealed that the lesion had initially appeared 30 years ago and had become more widespread over time. It was not affecting her breathing or sense of smell. Her relatives and friends would comment about them and wherever she would go, people would stare at her. The disfiguring lesions were a cause of low self-esteem for her. She further stated that she underwent laser therapy at a private medical clinic but the lesions showed no improvement and the treatment was quite expensive. Therefore, she decided to discontinue the treatment.
Doctors advised a depression screening which did not reveal that the patient was depressed. Her blood tests showed good glycemic and blood lipid control. Doctors advised her to continue with her current medication. Similarly, referred her to a dermatologist for further assessment and management of the skin lesions. Skin biopsy findings were consistent with the diagnosis of trichoblastoma with no evidence of malignancy. She was further referred to a plastic surgeon for management. And after a detailed discussion, the patient chose to undergo laser treatment.
