Folliculitis perforating L73.8

Mehregan and Coskey, 1968

Chronic, follicular and perifollicular necrotizing inflammation of unknown origin. It is assumed that due to pathological cornification processes in the follicleostium, the hair breaks through the follicular epithelium and thus maintains a chronic inflammation. S.a.u. Hyperkeratosis follicularis uraemica. The disease has an eminently chronic, year-long course.

In recent years, increasing descriptions of the clinical picture under treatment with tyrosine kinase inhibitors. Continued occurrence in HIV-infected persons.

Triggering by chemical substances, e.g. formaldehyde in clothing, is being discussed. The disease is also observed in patients with diabetes mellitus and chronic terminal renal failure (see also"reactive perforating collagenosis". In contrast to this disease, the Koebner phenomenon cannot be triggered). Also occurs in HIV-infected persons.

First appearance of skin changes between the ages of 20 and 40. No gender bias.

Extremities, buttocks. Generalized forms with extension to the trunk indicate a systemic triggering basic disease!

0.2-0.5 cm large, slightly raised, reddened, sometimes itchy, red, follicular papules with a central horn plug. Small, punctiform bleedings when the clot is removed.

In the dilated follicles ortho- and parakeratotic horn material is found mixed with basophilic cell detritus and eosinophilic, degenerated elastic fibers. Perforation of the material by the follicular epithelium of the infundibulum is best detected in serial sections. Perifollicular inflammatory infiltrate.

Keratosis follicularis; hyperkeratosis follicularis et parafollicularis in cutem penetrans, reactive perforating collagenosis.

Avoid triggering clothing. Keratolytic ointments or spirit with salicylic acid 2-5% (e.g. R214, Salicylvaseline Lichtenstein), possible combination with wound healing agents such as dexpanthenol. Benzoyl peroxide (BPO) 3-20% in gel, lotion and wash solution (Panoxyl emulsion 10%, Panoxyl mild 2,5%), azelaic acid 20% cream (Skinoren).

Cave!

Do not apply preparations containing benzoyl peroxide to the mucous membranes; caution is advised for atopic persons!

Treatment trial with aromatic retinoids (e.g. neotigason) 0,5 mg/kg bw/day. Afterwards reduction to individual maintenance dose (10-20 mg/day), do not dose more than 0.2 mg/kg bw/day. The systemic therapy should be combined with the external treatment.

1. Batalla A et al. (2014) Delayed onset perforating folliculitis associated with sorafenib. Australas J Dermatol 55:233-235

2. Kawakami T et al. (2020) Clinical practice guide for the treatment of perforating dermatosis. J Dermatol 47:1374-1382

3. Kruger K et al. (1999) Acquired reactive perforating dermatosis. Successful treatment with allopurinol in 2 cases. Dermatologist 50: 115-120
4. Mahajan S et al. (2004) Perforating folliculitis with jaundice in an Indian male: a rare case with sclerosing cholangitis. Br J Dermatol 150: 614-616
5. Mehregan AH, Coskey RJ (1968) Perforating folliculitis. Arch Dermatol 97: 394-399
6. Pavlovic MD et al (2003) Trauma-induced perforating folliculitis. Eur J Dermatol 13: 592
7. Rubio FA et al (1999) Perforating folliculitis: report of a case in an HIV-infected man. J Am Acad Dermatol 40:300-302

8. Wolber C et al. (2009) Perforating folliculitis, angioedema, hand-foot syndrome--multiple cutaneous side effects in a patient treated with sorafenib. J Dtsch Dermatol Ges 7:449-452