Perifolliculitis capitis abscedens et suffodiens L66.3

Rare, almost only in men occurring, abscessing, fistula, chronic hair follicle inflammation. Occurs within the acne triad. The clinical picture must be separated from the folliculitis decalvans. Folliculitis decalvans lacks the clinical relation to acne conglobata as well as the formation of fistula ducts.

Especially common among members of the black population/person of color.

Occurs in men with severe seborrhoea between the ages of 20 and 40 (Scheinfeld N 2014).

Folliculitis decalvans: Clinically no evidence of acne conglobata. No evidence of fistula ducts.

Acne keloidalis(Folliculitis scleroticans nuchae): Infestation of the neck region; no fistula ducts. No evidence of acne conglobata.

Hidradenitis suppurativa: Does not affect the capillum

Tuberculosis cutis colliquativa: Extremely rare disease pattern in the western hemisphere. Clinical and histological evidence of the underlying tuberculosis.

Actinomycosis: Localization capilltium atypical; no evidence of acne conglobata

Antibiotics: in a smaller study, the combination of clindamycin/rifampicin (each 200mg/2xday p.o.) was described as successful over a period of 10 weeks (Scheinfeld N 2014).

Retinoids such as isotretinoin (e.g. Aknenormin®) 0.2-0.5 mg/kg bw/day. In the further course reduction of the dose to 10mg 2-3x/week.

Moderate success is also seen with hydroxychloroquine 150 mg/day p.o. (own experience is negative).

Individual case reports document positive success with a combination therapy of dapsone (100 mg/day) and isotretinoin (1 mg/kg bw/day) as well as with monotherapeutic TNF-alpha blockers.

Together with acne inversa, acne conglobata and pilonidalsinus, the disease is summarized as the "tetrade of follicular occlusion".

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