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Folliculitis perforatingL73.8

Author:Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

perforated folliculitis; Perforating folliculitis

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HistoryThis section has been translated automatically.

Mehregan and Coskey, 1968

DefinitionThis section has been translated automatically.

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.

Occurrence/EpidemiologyThis section has been translated automatically.

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

EtiopathogenesisThis section has been translated automatically.

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.

ManifestationThis section has been translated automatically.

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

LocalizationThis section has been translated automatically.

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

Clinical featuresThis section has been translated automatically.

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.

HistologyThis section has been translated automatically.

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.

Differential diagnosisThis section has been translated automatically.

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

External therapyThis section has been translated automatically.

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!

Internal therapyThis section has been translated automatically.

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.

LiteratureThis section has been translated automatically.

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

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

  7. 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

Authors

Last updated on: 29.10.2020

Author: Prof. Dr. med. Peter Altmeyer