Lesions are asymptomatic and slow growing, with a diameter of 0.2-1.0 cm. Lesions have a central punctum through which the patient would note the presence of cottony hair extruding from the bump. Folliculomas are solitary tumors, most commonly found on the face or occasionally the scalp. The lesion is a firm, slightly elevated, pearly tumor with a central crater or punctum containing keratinous material or a wisp of wool-like or cottony hairs, usually white, protruding from it. If hairs protrude from the crater, the diagnosis is strongly suspected, as clinically, this is a highly diagnostic feature.
Lesions are organoid, or hamartomatous, adnexal tumors of hair follicle origin.
Once the diagnosis of folliculoma is established, either clinically or histologically, no laboratory workup is indicated. No imaging studies are indicated for this entity. Folliculomas demonstrate a central pore leading to a large cavity in the dermis. The cavity reveals buds of hair roots on the sides and base of numerous well-formed sinuses. These maldeveloped hair follicle units possess a dermal papilla, a hair matrix, and the rudiments of root sheaths.