P8.99 AN UNUSUAL  CASE OF PERIFOLLICULITIS ABSCEDENS ET SUFFODIENS

Mónica Ramos, Rocío Ferrusco, Marco Rodriguez

Instituto Dermatologico de Jalisco“ Dr. José Barba Rubio“ Guadalajara, México.

The patient is a 12 year-old Mexican girl, presenting with a one month old history of hair loss and abscesses. On physical examination she had alopecia, scaring, and multiple lobulated and fluctuant abscesses, which were in a diffuse pattern mainly on the parietal and temporal regions. There was no lymphadenopathy. Mycological studies were negative, and Staphylococcus aureus was isolated from the bacterial cultures of the purulent discharge from the lesions. Routine blood tests, phagocytic index and blastoid maturation were normal. Histopathologic examination showed granulomas consisting of lymphocytes,, plasma cells and giant cells.

Treatment was initiated with Trimetroprim 160mg, Rifampicin 300mg daily and nonsteroidal antinflamatory analgesics for 2 weeks, without producing a satisfactory response. Therefore, the antibiotic regime was changed  to Dicloxacillin 500mg qds, and sulfone 100mg daily for another 2 weeks; this time with a partial response. Physical examination at this point revealed 90% of the scalp alopecia without the presence of abscesses and there were only some queratotic crusts. The antibiotic therapy was suspended, and treatment with Isotretinoin 20mg od ( 0.5mg/Kg/d ) was started  for 7 weeks. Unfortunately, this treatment  had to be suspended due to an elevation  of  triglycerides (638mg) and very low density lipoproteins (128mg), as well as a worsening of the clinical  condition of the patient, who had multiple fluctuant  abscesses, despite lanugo hair growth. Therefore treatment with prednisone 50mg daily (1mg/Kg/d) was started, as well as Cephalexin 500mg tid for 14 days. The steroid dose was reduced gradually, as a favorable response, in terms of a reduction in the number of abscesses in addition to almost complete regrowth of the scalp hair, was shown.

At this moment the patient has regrowth of almost 95% of her scalp hair.

This case is submitted because of the atypical presentation, age and evolution.