Perifolliculitis Capitis Abscedens Research Articles

Perifolliculitis capitis abscedens et suffodiens successfully controlled with infliximab

Conflicts of interest: none declared. Sir, Perifolliculitis capitis abscedens et suffodiens (dissecting cellulitis or dissecting folliculitis) manifests with perifollicular pustules, nodules, abscesses and sinus tracts on the scalp, eventually resulting in extensive scarring alopecia. When it is associated with acne conglobata and hidradenitis suppurativa the syndrome is referred to as the follicular occlusion triad, and when also with pilonidal cysts as a tetrad.1 The frequent association of these diseases suggests a common pathogenesis. Its course is chronic and relapsing, and treatment is frequently difficult. Therapies include isotretinoin, antibiotics, prednisone, X‐ray therapy, surgical excision and skin grafting.2 Tumour necrosis factor (TNF) is a proinflammatory cytokine that seems to play an important role in the pathogenesis of these diseases. Infliximab is a chimeric monoclonal antibody that binds specifically to TNF‐α, decreasing the effect of the cytokine in inflammatory diseases. Infliximab monotherapy has been shown to be an effective therapeutic alternative for severe extensive forms of hidradenitis suppurativa.3

Successful treatment of perifolliculitis capitis abscedens et suffodiens with combined isotretinoin and dapsone

Perifolliculitis capitis abscedens et suffodiens (PCAS) is a rare scalp disease of unknown etiology which is hard to treat. It is often accompanied by scarring alopecia, acne conglobata, and recurrent fluctuant abscesses. PCAS belongs to the family of acne inversa (hidradenitis suppurativa). A 19-year-old man presented with PCAS for 2 years; multiple systemic antibiotic therapies and surgical approaches had shown no effect. Monotherapy with isotretinoin 80 mg daily for 4 weeks had not been successful. Combination therapy with dapsone 100 mg and isotretinoin 80 mg daily produced significant improvement. During 4 weeks of treatment significant clearing was achieved. Dapsone was reduced to 50 mg daily after 6 months, while isotretinoin was discontinued gradually. Now the patient is on dapsone 50 mg every other day and has remained free of recurrences for 6 months.

Perifolliculitis Capitis Abscedens et Suffodiens in an 18-Year-Old Aboriginal Canadian Patient: Case Report and Review of the Literature

Perifolliculitis capitis abscedens et suffodiens (PCAS) is a suppurative process that involves the scalp, eventually resulting in extensive scarring and irreversible alopecia. This condition often presents in males of African American origin. This article describes the clinical presentation, diagnosis, and treatment of an Aboriginal Canadian male suffering from PCAS. A literature review on the etiology, pathology, differential diagnosis, and management is also discussed. Careful analysis of the pathology and clinical presentation can aid in the timely diagnosis and management of this challenging condition. The clinician dealing with patients suffering from PCAS has several treatment options available to help successfully manage patients with straightforward or recalcitrant disease.

Perifolliculitis capitis abscedens et suffodiens

Perifolliculitis capitis abscedens et suffodiens (PCAS) is rare chronic, suppurative and inflammatory scalp disease. Its aetiology and pathogenesis is not completely understood. The treatment is usually difficult and often disappointing. We report a case of 29-year-old male who presented with tender, fluctuant nodules and abscesses, with draining pus and patchy alopecia on his scalp for 3 years. A skin biopsy from scalp lesions revealed features that are characteristic of perifolliculitis. Initially, the patient was treated with periodic incision and drainage of the scalp abscesses. The answer was very poor. When admitted to our department, isotretinoin was started at daily dose of 30 mg, because initially his cholesterol and triglyceride levels were mildly increased. When dose was reduced to 10 mg the levels of cholesterol and triglyceride remained normal. A response to treatment was excellent and rapid. The treatment of PCAS represents usually difficulties and frustration for both the patient and the physician. A long course of isotretinoin can be considered as one of the most effective treatment for PCAS.

Hidradenitis suppurativa: response to treatment with infliximab

Hidradenitis suppurativa (HS) is a chronic, painful, inflammatory disorder involving apocrine glands. An underlying defect in immunity is proposed as HS is associated with Crohn’s disease, pyoderma gangrenosum, and seronegative arthropathies. HS is one of the follicular occlusion triad that include acne conglobata and dissecting cellulitis of the scalp.

A Case of Dissecting Cellulitis and a Review of the Literature

Dissecting cellulitis (also called perifolliculitis capitis abscedens et suffodiens) manifests with perifollicular pustules, nodules, abscesses and sinuses that evolve into scarring alopecia. It predominantly occurs in African American men between 20-40 years of age, but can occasionally affect other races and women too. Associated musculoskeletal findings are sometimes reported. When it occurs with acne conglobata, hidradenitis suppurativa, and pilonidal cysts, the syndrome is referred to as the follicular occlusion triad or tetrad. Its course is chronic and relapsing, and treatment is often difficult. Medical therapies include isotretinoin, antibiotics, and prednisone. Destructive therapies include X-ray therapy, surgical excision, and skin grafting. Laser epilation of hair follicles is a promising new therapy for dissecting cellulitis.

Tufted folliculitis of the scalp: a distinctive clinicohistological variant of folliculitis decalvans.

Tufted folliculitis is an uncommon folliculitis of the scalp that resolves with patches of scarring alopecia within which multiple hair tufts emerge from dilated follicular orifices. The clinicohistological data from a group of 15 patients with tufted folliculitis were reviewed and compared with those of seven patients with folliculitis decalvans, five with acne keloidalis nuchae, four with dissecting cellulitis of the scalp, three with kerion celsi and 20 with follicular lichen planus. It was found that tufted folliculitis could be differentiated from folliculitis decalvans only by finding several hair tufts scattered within patches of scarring alopecia. Histologically, a single tuft consisted of peculiar clustering of adjacent follicular units opening at the bottom of an epidermal depression. Conversely, the presence of keloidal plaques in acne keloidalis nuchae, coalescing nodules discharging purulent material in dissecting cellulitis of the scalp, erythematous plaques covered by pustules replete with fungal elements in kerion celsi, and the absence of follicular pustules in follicular lichen planus distinguished these diseases from tufted folliculitis. On the basis of these findings, it is suggested that tufted folliculitis should be considered as a distinctive clinicohistological variant of folliculitis decalvans. Tufting of hair is caused by clustering of adjacent follicular units due to a fibrosing process and to retention of telogen hairs within the involved follicular units.

Dissecting cellulitis of the scalp: response to isotretinoin

We report three patients with dissecting cellulitis of the scalp. Prolonged treatment with oral isotretinoin was highly effective in all three patients. Furthermore, long-term post-treatment follow-up in two of the patients has shown a sustained therapeutic benefit.

MUSCULOSKELETAL FEATURES OF ACNE, HIDRADENITIS SUPPURATIVA, AND DISSECTING CELLULITIS OF THE SCALP

This article describes the various forms of acne and the clinical and radiographic features of the associated musculoskeletal manifestations. Occasionally, acne may occur together with hidradenitis suppurativa and dissecting cellulitis of the scalp, the so called "follicular occlusion triad." The current understanding of the etiology of these conditions and their treatment are also reviewed.

Treatment of perifolliculitis capitis abscedens et suffodiens with isotretinoin

Perifolliculitis capitis abscedens et suffodiens is a rare condition characterized by recurrent interconnected abscesses and patchy alopecia of the scalp. Numerous treatments have been used in this condition with varying degrees of success. We report a case successfully treated with isotretinoin.

Dissecting Cellulitis of the Scalp in 2 Girls

Two girls with dissecting cellulitis of the scalp are described. In one Pseudomonas aeruginosa was isolated from the sinus discharge. Both patients were controlled with prolonged antibiotic therapy and periodic aspiration of the fluctuant lesions. Role of infection in perpetuating the condition is highlighted.

Dissecting cellulitis of the scalp.

Dissecting cellulitis of the scalp or perifolliculitis capitis abscedens et suffodiens is a rare, chronic, progressive, suppurative disease of the scalp of unknown etiology. It is characterized by painful nodules, purulent drainage, burrowing interconnecting abscesses, and cicatricial alopecia. The pathogenesis is unknown, although it is probably related to follicular occlusion, secondary infection, and deep inflammation. Black men in their second to fourth decade are predominantly affected. Treatment varies from systemic antibiotics to incision and drainage, x-ray epilation of the affected areas, systemic steroid administration, and surgical excision. Our experience with four patients with extensive scalp disease is presented. Wide excision of the affected areas and splitthickness skin graft are favored as our treatment of choice.

Perifolliculitis Capitis Abscedens et Suffodiens (Hoffman)

A 24-year-old man with a one-year history of perifolliculitis capitis abscedens et suffodiens (Hoffman) was treated with oral zinc sulfate. Complete healing was seen after three months and the treatment was continued for a total of six months. No relapse has occurred during a five-year follow-up. The mechanisms through which zinc therapy might influence inflammatory conditions are not fully understood.

Perifolliculitis Capitis Abscedens et Suffodiens

A severe case of perifolliculitis capitis abscedens et suffodiens, refractory to the usual therapy, is reported. Because the disease is chronic, and the excellent results obtained in the excision and graft of axillae with severe hidradenitis suppurativa, the patient was scalped therapeutically with excellent results.

MANAGEMENT OF DERMATOSES PECULIAR TO NEGROES.

A statistical tabulation was made of dermatoses seen in private practice in 3,860 consecutive Negro patients. The incidence of skin diseases in this group has been compared with that found in a recent study of an overwhelmingly Caucasian sample. Negro patients were found to have a higher incidence of atopic dermatitis and fungus infections, but less acne, fewer warts, and a much lower incidence of psoriasis, localized neurodermatitis, epithelioma, and keratoses. Therapeutic suggestions and comments have been made regarding vitiligo, hyperpigmentations, pseudofolliculitis of the beard, acne keloidalis, perifolliculitis capitis abscedens et suffodiens, and dermatosis papulosa nigra.

Perifolliculitis capitis abscedens et suffodiens; its successful treatment with x-ray epilation.

Perifolliculitis capitis abscedens et suffodiens is a chronic inflammatory disease of the scalp characterized by the presence of large and small nodules which suppurate and intercommunicate by sinus formation. It occurs most frequently on the vertex and occiput and is predominantly a disease of males. It is a condition renowned for its resistance to therapy. Even in this age of potent antimicrobial therapy the disease is still very difficult to manage. Because of our knowledge of the fundamental importance of drainage in abortion of infection and the observation that folliculitis of the bearded areas at times does not respond to antibiotic therapy unless drainage is established by manual epilation, it occurred to us that perhaps temporary epilation induced by irradiation might have a similar favorable effect upon this disease. The following are case reports of four patients successfully treated by this modality after the

Perifolliculitis capitis abscedens et suffodiens with rheumatoid arthritis; report of a case.

Perifolliculitis capitis abscedens et suffodiens is a rare infection of the scalp. It was first described as an entity under this name in 1907 by Hoffmann.¹The first case in this country was reported in 1921 by Wise and Parkhurst²as "a rare form of suppurative and cicatrizing disease of the scalp." Since then little more than two dozen cases have been reported or presented, the majority of them in Negroes. Some of the observers believe that the affection is related to acne conglobata. There is undoubtedly some resemblance, and as in acne conglobata etiology and pathogenesis remain unexplained. Pyogenous cocci have been demonstrated in some cases and were absent in others. The morphologic picture is one of more or less insidiously growing and spreading nodules, infiltrations, abscesses, and sinuses, which undermine large areas of the scalp and lead to scar formation and loss of hair.

A RARE FORM OF SUPPURATING AND CICATRIZING DISEASE OF THE SCALP

A chronic inflammatory disease of the scalp, primarily perifollicular, leading to suppuration and extensive undermining of the involved area, was given the name Perifolliculitis capitis abscedens et suffodiens by E. Hoffmann. He presented such a case before the Berlin Dermatological society, Nov. 12, 1907. Hokmann's patient, a man aged 25, had then been afflicted for a year, and showed the occiput many (about 20) nearly hazelnut sized, pale, hemispherical elevations, hairless or covered at the borders with sparse, short hair stumps, from which on pressure pus exuded and into whose fistulous openings the sound could be introduced up to 4 or 5 cm. Beside these closely crowded tumors with smooth, pale, grayish-red surfaces, which gave the scalp a rough, uneven, mammillated appearance, there were a few disseminated pustules and crusts, pierced by hairs, and isolated, small coin-sized, smooth scars. Healing resulted in further scar formation and was hastened by