P-34   TUFTED HAIR FOLLICULITIS – REPORT OF TWO CASES

V. Karászi, *K. Gyurcsovics, K. Preisz, M. Marschalkó, J. Hársing, G. Bottlik, A. Horváth Dept. of Dermato-Venereology Semmelweis University, Budapest; *Petz Aladár County Hospital GyŒr; Hungary.

Tufted hair folliculitis (THF) is a rare, inflammatory and exsudative disease of the scalp characterized by multiple bundles of hairs emerging from single dilated follicular openings, and results a permanent and irreversible scarring alopecia. In most of the cases Staphylococcus aureus can be cultured from the affected lesions. Histopathological studies reveal perifollicular inflammation around the upper portions of the follicles with complete sparing at the hair root level. We report two cases of THF, which are the first cases from Hungary to be reported. Case 1. A 63- year old woman presented with a half-year history of scaly, erythematous, pruritic, sometimes even painful plaque on the parietal region of the scalp. Physical examination showed hyperaemic, inflammatory area with bundles of hair shafts of 5-7 normal looking hairs arising out of dilated hair follicles. Staphylococcus aureus was found to be present in the bacterial cultures, fungal cultures were negative. Laboratory tests were normal or negative including blood count, liver and kidney function tests, immunological studies (antinuclear antigen, serum immunoglobulins, complement). Treatment with topical antibiotic ointment stopped the inflammation. Case 2. A 29-year old woman presented with a 7-year history patchy hair loss on the scalp. Physical examination showed a well-defined area of scarring alopecia on the parieto-occipital region with several hair tufts within this area. Investigations, including routine blood tests, antinuclear antigen and immunoglobulins, as well as mycology and microbiology cultures were normal and negative. Histology of the affected area confirmed a cicatricial process but excluded conditions such as lupus erythematosus or lichen planus. Direct immunofluorescence studies were negative. Several pathogenetic mechanisms have been proposed to explain the development of tufted folliculitis, including naevoid abnormalities, retention of telogen hairs in the tufts, and an infective folliculitis leading to destruction of the upper parts of adjacent follicles. Some authors believe hair tufting to be a secondary phenomenon that may occur in several different inflammatory diseases of the scalp, rather than a diagnostic feature of a specific disease.