Successful Management of Multiple Trichoepitheliomas in Identical Twins Using Combined Cryotherapy and Topical Tretinoin: A Four-Year Follow-up Case Report

Background: Trichoepithelioma is a rare benign adnexal tumor of hair follicle origin. When multiple papules affect cosmetically sensitive areas, treatment is challenging. Literature reports show both surgical/ablative and pharmacologic options (topical tretinoin, imiquimod) used with varied success.

Case: A 15-year-old Omani female with a three-year history of multiple slow-growing whitish papules over the nasal bridge and perinasal area. Her identical twin sister had similar lesions. Examination and biopsy confirmed multiple trichoepitheliomas.

Management: Treated with cryotherapy (liquid nitrogen, 20 seconds per lesion, two sessions) plus topical tretinoin cream (0.025–0.05%) applied daily.

Outcome: Marked cosmetic improvement, with an estimated 90% reduction in lesion count and no new lesions, by the latest follow-up at approximately four years. Mild transient erythema and dryness reported, managed with emollients. No scarring or recurrence observed.

Conclusion: Combined cryotherapy and topical tretinoin may represent a practical, safe, and effective treatment for multiple trichoepitheliomas, particularly in young patients with lesions in cosmetically important facial regions.