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P8.108 Two cases of tufted folliculitis Nicole Orendain Koch Department of Dermatology, Resident at Jalisco´s Dermatology Institute Buenos Aires, Providencia Guadalajara, Jalisco, Mexico Introduction: Tufted folliculitis is an inflammatory, purulent and recurrent progressive disease of the scalp, producing characteristically multiple hair tufts in the area affected. The destruction of the follicles produces scarring alopecia. Tufted hair folliculitis is a rare condition, described for the first time by Tagami in 1970 as "numerous multiple hairs." It affects both sexes with a male to female ratio of 2.7:1, and has been reported in patients between the ages of 19 and 68 years. Case 1: 53 year old Mexican male, presenting with a 10 year old history of pustules and hair loss. On physical examination he had a plaque with whitish adherent scales measuring 10x10cm in the right parietal and occipital region, with pseudoalopecia and the presence of multiple hair tufts, with 2-10 hair shafts emerging from one follicle. Case 2: 34 year old Mexican male, presenting with a 3 year old history of a minor head injury, followed by a persisting crust with hair loss in the same area. On physical examination the patient had a scaly whitish plaque of 8x9cm, with the presence of 10-20 hair shafts in each follicular ostium. Both patients had positive cultures for Staphylococcus aureus, negative mycological studies, and responded partially to prolonged treatment with erythromycin, with neither regression nor progression of the illness.Commentary: The etiology of tufted folliculitis is still unknown - the different hypotheses include: infectious causes (due to Staphylococcus aureus), retention of telogen hairs, and traumatic causes, amongst others.The treatment of this relapsing condition leading to progressive scarring alopecia has been notoriously difficult. Systemic antibiotics produce only a brief response, without permanent eradication. Corticosteroids suppress the inflammatory response, but produce only slight improvement and have no lasting effects after treatment stops. Other treatments include topical and systemic retinoids, zinc sulphate, rifampicin, as well as surgery, all without great success. The two cases we reviewed fit in the sex and age group reported in the literature, and both cases had Staphylococcus aureus as the causal agent. In the second patient, a history of trauma was followed by alopecia. In both patients there was no progression of the disease with treatment (erythromycin). Tufted folliculitis should be considered a different clinical and histopathological entity within the folliculitis decalvans, and its early recognition and treatment might prevent the progression of the illness. |
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