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PubMed1997

[Tufted hair folliculitis].

A case of tufted hair folliculutis presenting as circumscribed, tender and inflamed areas in the occiput with residual tufted follicles in a 28-year old man is reported. Tufted hair folliculitis is a characteristic localized scarring bacterial folliculitis of the scalp due to Staphylococcus aureus. Histopathological studies reveal perifollicular inflammation around the upper portions of the follicles sparing the hair root level. Within areas of inflammation, several follicles converge toward a common follicular duct with a widely dilated opening. Currently, tufted hair folliculitis is considered a variant of folliculitis decalvans of Quinquaud. Staphylococcal infection is believed to be an initial causative factor, and underlying differences in follicular anatomy or host response may be important in determining which reaction pattern occurs in an affected individual. The development of atrophy with loss of adnexal structures (in folliculitis decalvans) or of hair tufts (in tufting folliculitis) may depend upon the depth and destructive potential of the inflammatory process. The therapeutic approach is problematic; prolonged treatment with oral antibiotics may stabilize the disease, but good and at times more definitive results (as in the presented case) have been reported after radical surgical excision of the involved areas.

Adult↗
PubMed2004

Failure to detect clonality in eosinophilic pustular folliculitis with follicular mucinosis.

Eosinophilic pustular folliculitis is characterized by an eosinophil-rich inflammatory follicular and perifollicular infiltrate primarily centred at the level of the follicular isthmus and sebaceous duct. Follicular mucinosis has been observed in lesions of eosinophilic pustular folliculitis. Clinical and histological features of eosinophilic pustular folliculitis with follicular mucinosis and alopecia mucinosa are very similar. Alopecia mucinosa may be a clonal T-cell dermatosis. A monoclonal re-arrangement of the T-cell receptor gene was detected in about half of the cases in alopecia mucinosa. To investigate T-cell clonality in a series of eosinophilic pustular folliculitis with follicular mucinosis, we performed heteroduplex analysis of re-arranged T-cell receptor gamma gene in seven cases of eosinophilic pustular folliculitis with follicular mucinosis. All cases were negative for heteroduplex-PCR analysis. The failure to demonstrate clonality may be consistent with a reactive nature of eosinophilic pustular folliculitis with follicular mucinosis.

Adolescent↗
PubMed2006

Community-acquired methicillin-resistant Staphylococcus aureus skin infection presenting as a periumbilical folliculitis.

Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection is a clinical problem of increasing global incidence. CAMRSA most commonly presents as abscess and cellulitis of the skin and soft tissue. However, the lesions of cutaneous CAMRSA infection are pleomorphic and may appear as erythematous pustules of superficial folliculitis. This report presents the cases of 2 patients with CAMRSA skin infection that presented as a superficial folliculitis. The distribution of CAMRSA-related, erythematous, folliculocentric pustules was periumbilical, in contrast to the lesional location of methicillin-susceptible S. aureus (MSSA)-associated folliculitis, which typically appears on the axillae, bearded area, buttocks, and extremities. CAMRSA should be considered in the diagnosis of periumbilical folliculitis or superficial folliculitis arising in areas not typically affected by MSSA-related folliculitis, such as the chest, flanks, and scrotum.

Abdomen↗
PubMed1991

Human immunodeficiency virus-associated eosinophilic folliculitis. A unique dermatosis associated with advanced human immunodeficiency virus infection.

We studied 13 patients with human immunodeficiency virus (HIV) infection and a chronic pruritic folliculitis that was unresponsive to systemic treatment with bactericidal anti-staphylococcal antibiotics. The skin eruption was characterized by multiple urticarial follicular papules scattered on the trunk (100%), the head and neck (85%), and the proximal aspect of the extremities (62%). Absolute peripheral eosinophil counts were increased in six of 13 patients; a relative peripheral eosinophilia was present in 10 of 13 patients. Serum IgE levels were elevated in all seven patients tested (range, 88 to 9050 IU). Histopathologic features included a folliculitis with eosinophils. Pathogenic bacteria were not consistently found by routine bacterial skin cultures, cultures of skin biopsy specimens, or histopathologic evaluation. CD4 counts were decreased in all of the 12 patients tested (less than 300 cells per cubic millimeter) and were below 250 cells per cubic millimeter in 10 patients. A clinical response was noted to astemizole, to ultraviolet light in the B range, and to topical clobetasol propionate. These observations demonstrate that HIV-associated eosinophilic folliculitis is a unique HIV-related cutaneous disorder that is characterized by a culture-negative, chronic, pruritic folliculitis and a characteristic histopathologic picture. Of special importance, because it is associated with CD4 counts of less than 250 to 300 cells per cubic millimeter, eosinophilic folliculitis appears to be an important clinical marker of HIV infection and, particularly, of patients at increased risk of developing opportunistic infections. We suggest that the term eosinophilic pustular folliculitis (Ofuji's disease), previously used to describe this dermatosis in HIV-infected patients, should be discarded.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Perforating folliculitis].

We report the case of a 20-year old male patient without significant familial or personal history who presented with a disseminated papular eruption on the abdomen, flanks and buttocks. The eruption was continual and proceeded by outbreaks, but it was not influenced by seasons. Physical examination of the skin, mucosae and skin appendages was otherwise normal. Histological examination showed all the criteria of perforating folliculitis as described by Mehregan and Coskey. On the basis of our case we would put perforating folliculitis back among the perforating dermatoses. The concept of this curious phenomenon is briefly reviewed; perforating folliculitis is part of the third group of the so-called primary forms. The clinical features are suggestive of the disease, with its small pigmented papules centred around a keratotic plug, forming a permanent disseminated eruption. Histology shows a granuloma facing a lateral perforation of the hair follicle, a pseudo-epitheliomatous epithelial hyperplasia and the presence of hair and keratin debris in the perforation. Various keratolytic treatments have been applied without success; retinoids have not been tried. The main diagnostic and nosological problem is Kyrle's disease. In view of clinical and histological data, many authors regard Kyrle's disease as a major form of perforating folliculitis. Pruritus, ascribed to an underlying illness in Kyrle's disease, is thought to increase the importance of the lesions. The specificity of perforating folliculitis is discussed, but it seems that side by side with secondary forms occurring in recognized diseases, there may be primary forms of perforating folliculitis. Dyskeratosis might be a cause of the perforation.

Adult↗
PubMed2002

Herpetic folliculitis.

BACKGROUND: Although herpetic skin infection is very common, herpetic folliculitis is infrequently reported in the literature. It has varied presentations, some of which are clinically atypical requiring histopathological confirmation of follicular involvement. OBJECTIVE: We describe an otherwise healthy young adult male with extensive herpetic sycosis of the beard area, which is a variant of herpetic folliculitis. The diagnosis was confirmed by typical herpetic cytopathic changes in Tzanck smear and positive viral culture for HSV-1. METHOD: This article includes a case report and a literature review of herpetic (simplex and varicella/zoster) folliculitis. CONCLUSIONS: More cases of herpetic folliculitis should be reported to improve our understanding of this disease entity. Physicians should consider herpetic or other viral etiology in patients with folliculitis even if they were healthy, especially if they show resistance to antibacterial and antifungal therapy.

Adult↗
PubMed2002

The histopathology of folliculitis in HIV-infected patients.

BACKGROUND: Cutaneous disease referable to human immunodeficiency virus (HIV) infection has become less common with the advent of widespread administration of antiretroviral medications, particularly the protease inhibitors. Pruritic eruptions that fall into the general categorization of folliculitis continue to be problematic. METHODS: In this report, we describe 33 skin biopsy samples prospectively obtained of follicular papules and pustules from 33 HIV-infected individuals with the clinical diagnosis of HIV-related folliculitis. RESULTS: The histopathologic findings were stratified as follows: (i) acute folliculitis with bacteria and/or yeast (n = 9); (ii) lymphocytic perifolliculitis (n = 7); (iii) eosinophilic folliculitis (n = 5); (iv) perifolliculitis with mixed inflammation (n = 11); (v) follicular rupture with predominant granulomatous inflammation (n = 1). Demodex organisms were found in 10 specimens scattered among these categories. CONCLUSIONS: The histopathology of folliculitis in HIV-infected patients is protean. No single factor could be identified as the cause, making targeted antibacterial or antifungal therapy unlikely to be successful across a wide range of patients.

Female↗
PubMed1999

Bacteriologic and immunologic aspects of gram-negative folliculitis: a study of 46 patients.

BACKGROUND: Gram-negative folliculitis is an infection with gram-negative rods that most often occurs as a complication of prolonged broad-spectrum antibiotic therapy in patients suffering from acne and rosacea. METHODS: The bacteriologic and immunologic findings are reported in 46 patients, 39 men and 7 women, aged 16-79 (median, 28) years, with gram-negative folliculitis. Hypersensitivity reactions to various microbial recall antigens as well as granulocyte functions were evaluated. Quantitative measurements of serum levels of immunoglobulin M, G, A, and E, total complement activity, complement factors C3 and C4, and alpha-1-antitrypsin were performed. RESULTS: The gram-negative organisms most frequently cultivated from nares, facial skin, and pustules were Klebsiella spp., Escherichia coli, Enterobacter spp., and Proteus spp. In all patients, deviations of one or more immune parameters were detected, including lowered serum concentrations of immunoglobulin M and alpha-1-antitrypsin, and elevated levels of immunoglobulin E. The humoral and cellular parameters were not influenced by isotretinoin therapy of gram-negative folliculitis. CONCLUSIONS: These findings suggest that gram-negative folliculitis is not only a complication of long-lasting antibiotic treatment of acne and rosacea, but might be an entity of its own. Immunologic factors may play a critical role in the pathogenesis of gram-negative folliculitis.

Adolescent↗
PubMed1999

HIV-associated eosinophilic folliculitis in an infant.

HIV-associated eosinophilic folliculitis (HIV-EF), which is a well-known entity in adults, has not been described in children. Although Ofuji's disease (OD) or eosinophilic pustular folliculitis (EPF) has been described in children and shares histopathologic features with HIV-EF, it is a distinct entity with characteristic clinical features. We report the occurrence of eosinophilic folliculitis in an 8-month-old HIV-positive patient and discuss the clinical, pathologic and possible pathogenetic aspects thereof. In addition, differences in the clinical manifestations of the present case and that of I-EPF are addressed. Because of clinicopathologic similarities between the present case and HIV-associated eosinophilic folliculitis (HIV-EF) in adults, we believe that eosinophilic folliculitis in this patient represents a cutaneous manifestation of HIV infection, rather than co-incidental occurrence of the infantile form of Ofuji's disease in an HIV-positive patient.

Adult↗
PubMed2006

Eosinophilic folliculitis in a Caucasian patient: association with toxocariasis?

Sterile eosinophilic folliculitis, a clinical entity first described by Ofuji in 1970, is a rather rare skin disorder, in particular in the non-Asian population. We report the first case of eosinophilic folliculitis associated with toxocariasis in a Caucasian patient. Topical and systemic anti-inflammatory and antiphlogistic therapy along with systemic antihelminthic treatment resulted in complete remission of the skin lesions. In addition, there was a marked decrease of antibodies to Toxocara antigens in the patient's serum following antihelminthic therapy. Given that (I) some cases of eosinophilic folliculitis have been reported which were associated with infestation with metazoan parasites; (2) infestations with the roundworm Toxocara canis are known to induce eosinophilic reactions in some tissues; and (3) therapy-induced remission of eosinophilic folliculitis was accompanied by a decrease of Toxocara-directed antibodies in the patient's serum, we propose that there is an aetiopathogenic link between toxocariasis and eosinophilic folliculitis in this patient.

Albendazole↗
PubMed1998

Sterile neutrophilic folliculitis with perifollicular vasculopathy: a distinctive cutaneous reaction pattern reflecting systemic disease.

The authors prospectively encountered skin biopsies from 20 patients which demonstrated a neutrophilic or suppurative and granulomatous folliculitis accompanied by a folliculocentric neutrophilic vascular reaction of Sweet's-like or leukocytoclastic vasculitis subtypes. While in each case the histomorphology raised diagnostic consideration of bacterial folliculitis, patients frequently expressed systemic complaints such as arthritis, fever, and malaise, and special stains for micro-organisms were negative. Among the clinical presentations were folliculitis, vasculitis, acneiform eruptions, vesiculopustular lesions, and erythema nodosum-like lesions, with the legs, arms, and upper back being the most commonly involved sites. Nineteen patients were found to have specific underlying systemic diseases, namely, inflammatory bowel disease, Reiter's disease, Behçet's disease, hepatitis B, connective tissue disease including mixed connective tissue disease and rheumatoid arthritis, scrofuloderma, and hematologic dyscrasias. The other patient had antecedent bacterial sinusitis in the setting of atopy. The folliculocentric nature of these lesions may reflect preferential processing of antigens through the hair follicle and/or homology between bacterial and follicular heat shock proteins in the susceptible host, namely, one who responds excessively to exogenous antigenic triggers. Folliculitis with folliculocentric vasculopathy may be a clue to underlying systemic disease and/or an extracutaneous infection. Certain light microscopic features in concert with the clinical presentation may distinguish such cases from conventional infectious folliculitis.

Adolescent↗
PubMed1997

Acne keloidalis nuchae and tufted hair folliculitis.

Acne keloidalis nuchae is a chronic, scarring folliculitis that affects mostly black patients and is located on the back of the neck of young adults. The course is progressive and leads to hypertrophic scarring, chronic abscesses and hair loss. We discuss the relationship between acne keloidalis and tufted hair folliculitis, pointing out the possibility that tufted hair folliculitis is not a specific disease but secondary to other progressive folliculitis like folliculitis decalvans, dissecting cellulitis or acne keloidalis.

Abscess↗
PubMed1987

Experimental folliculitis with Pityrosporum orbiculare: the influence of host response.

The aetiology of the folliculitis associated with seborrhoeic eczema is unclear, though the yeast, Pityrosporum orbiculare has been implicated. P. orbiculare was applied under occlusion to normal forearm skin of patients with seborrhoeic eczema (SE), seborrhoeic eczema and folliculitis (SEF), and normal controls. There were significant differences in response to occlusion between the three groups. Those patients with previous clinical evidence of folliculitis (SEF) developed folliculitis at the site of occlusion more frequently than either of the other two groups (p less than 0.001), in whom only one patient developed skin changes. This difference was not explained by the response to occlusion alone, nor by natural carriage of yeasts. These results suggest that the yeast P. orbiculare is necessary for the development of folliculitis, but that the nature of the host response determines those patients prone to follicular inflammation.

Dermatitis, Seborrheic↗
PubMedDate not supplied

Malassezia furfur folliculitis in cancer patients. The need for interaction of microbiologist, surgical pathologist, and clinician in facilitating identification by the clinical microbiology laboratory.

Malassezia furfur (MF) is a lipophilic yeast which can be found as a member of the indigenous microbiota of human skin. In immunocompromised transplant patients, MF can cause a distinctive folliculitis which is a clinical look-alike to Candida folliculitis, the latter of more potentially devastating significance. Recovery of MF in culture is dependent upon the addition to culture media of an exogenous source of fatty acids, such as olive oil. The addition of an extra Sabourauds plate with an olive oil overlay to the routine set of media used to inoculate all skin biopsy specimens in order to detect MF is labor-intensive and not cost-effective. Thus, MF may not be isolated in cases of MF folliculitis unless the clinical microbiology laboratory is put on alert by the clinical suspicions of the attending physician, or by histopathologic findings suggestive of folliculitis revealed by review of surgical pathology slides. The clinical, pathological, and microbiological findings of two cases of MF folliculitis are presented where an interactive approach featuring communication between the microbiologist, the surgical pathologist, and the clinician guided the microbiology laboratory to the isolation and identification of isolates of MF that were clinically-relevant. These cases underscore how a combined approach which features communication between the laboratory and the clinical services always provides superior guidance in the diagnosis and therapy of infectious diseases.

Adult↗
PubMed2001

Lymph folliculitis in ulcerative colitis.

Preferential involvement of the appendix has recently been confirmed in ulcerative colitis. Since the appendix is an aggregate of lymph follicles, this new observation implies a critical role of the lymph follicles, of both the large bowel and the appendix, in an etiopathogenesis of ulcerative colitis. This report presents two cases of ulcerative colitis in which lymph folliculitis and lymphoid hyperplasia were observed. Lymph folliculitis was observed endoscopically in a border between an established lesion and an uninvolved area. Case 1, proctitis type, relapsing remitting, mild in severity, showed lymph folliculitis in a proximal border of an established rectal lesion. Case 2, with left-sided colitis, mild in severity, had a skip appendiceal orifice inflammation. Lymph folliculitis was observed in the cecum surrounding established appendiceal orifice inflammation. In both cases, lymphoid hyperplasia was observed in an uninvolved area with clear vascular patterns. These two cases clearly demonstrate the involvement of gut lymph follicles in ulcerative colitis. Lymph folliculitis and/or lymphoid hyperplasia was proposed to be early lesions in ulcerative colitis. In addition, the need for microbiology targeting lymph follicles of the large bowel and appendix is stressed in order to disclose the casual microbial agents in ulcerative colitis.

Adult↗
PubMed1990

Skin surface electron microscopy in Pityrosporum folliculitis. The role of follicular occlusion in disease and the response to oral ketoconazole.

The yeast Pityrosporum orbiculare is thought to cause the folliculitis associated with seborrheic eczema. However, a combination of mechanical and microbiological factors may be involved, with follicular occlusion leading to yeast overgrowth and folliculitis. Scanning electron microscopy was used to investigate this hypothesis. Skin biopsy specimens obtained from patients with Pityrosporum folliculitis were examined by scanning electron microscopy before and after oral ketoconazole therapy. Patients with active disease showed occlusion of noninflamed follicles, which resolved after ketoconazole treatment. Follicular occlusion was not present in biopsy specimens obtained from unaffected controls nor was it related to the presence of P orbiculare. These findings suggest that follicular occlusion may be a primary event in the development of this folliculitis, with yeast overgrowth a secondary occurrence. The beneficial effect of ketoconazole in this disease may be due to direct effects on the follicle.

Administration, Oral↗
PubMed1990

Skin surface electron microscopy in Pityrosporum folliculitis. The role of follicular occlusion in disease and the response to oral ketoconazole.

The yeast Pityrosporum orbiculare is thought to cause the folliculitis associated with seborrheic eczema. However, a combination of mechanical and microbiological factors may be involved, with follicular occlusion leading to yeast overgrowth and folliculitis. Scanning electron microscopy was used to investigate this hypothesis. Skin biopsy specimens obtained from patients with Pityrosporum folliculitis were examined by scanning electron microscopy before and after oral ketoconazole therapy. Patients with active disease showed occlusion of noninflamed follicles, which resolved after ketoconazole treatment. Follicular occlusion was not present in biopsy specimens obtained from unaffected controls nor was it related to the presence of P orbiculare. These findings suggest that follicular occlusion may be a primary event in the development of this folliculitis, with yeast overgrowth a secondary occurrence. The beneficial effect of ketoconazole in this disease may be due to direct effects on the follicle.

Administration, Oral↗
PubMed1997

Viral folliculitis. Atypical presentations of herpes simplex, herpes zoster, and molluscum contagiosum.

BACKGROUND: Viral folliculitis is an infrequently reported entity. The patients described herein were seen over a 12-year period of practice in a referral dermatologic setting. The cases involve a variety of viral infections limited to the hair follicle. OBSERVATIONS: We describe 5 patients with a variety of viral folliculitides: 2 with herpetic sycosis caused by herpes simplex; 1 with herpex simplex folliculitis (this patient also had human immunodeficiency virus); 1 with herpes zoster without blisters; and 1 with molluscum contagiosum. CONCLUSIONS: These 5 cases demonstrate that viral folliculitis has varied causes and presentations. Clinicians should consider viral agents in the differential diagnosis of superficial infectious folliculitis, especially in cases that are refractory to antibacterial or antifungal therapy.

Adult↗