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Author: Dr Leah Jones, Medical Registrar, Christchurch, New Zealand. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. July 2020.
Perifolliculitis capitis abscedens et suffodiens is an uncommon cause of scarring alopecia characterised by perifollicular and follicular pustules and nodules .
It is also known as dissecting cellulitis of the scalp and Hoffman disease.
Perifolliculitis capitis abscedens et suffodiens is most prevalent in men of African descent in the third, fourth and fifth decades of life, but it may also affect African women, Caucasian individuals and other ethnicities, and occasionally, children [1,2].
Perifolliculitis capitis abscedens et suffodiens sometimes occurs in people who have other forms of follicular occlusion syndrome.
A defect in follicular keratinisation causes occlusion and subsequent inflammatory destruction of the follicle [2,3]. An aberrant immune to response to commensal bacteria may be involved with the pathogenesis, particularly coagulase-negative staphylococci .
Perifolliculitis capitis abscedens et suffodiens can affect single or multiple areas of the scalp, with a predilection for the vertex and posterior scalp . It is often painful.
Signs can include :
The clinical severity of perifolliculitis capitis abscedens et suffodiens depends on the size and number of the lesions, and the extent of the scarring and exudate .
Perifolliculitis capitis abscedens et suffodiens is also associated with arthritis and spondyloarthropathy , keratitis-ichthyosis-deafness syndrome , and sternocostoclavicular hyperostosis .
Hair loss is temporary initially, but the deep inflammation eventually leads to patchy cicatricial alopecia, which can be very extensive .
Cutaneous squamous cell carcinoma has been reported to arise in a chronically inflamed lesion .
Perifolliculitis capitis abscedens et suffodiens is a clinical diagnosis, based on the presence of typical draining pseudocysts on the scalp .
A swab of the exudate for culture is recommended to identify secondary bacterial infection [2,3]. The swab is often sterile.
A skin biopsy may show perifollicular mixed inflammatory infiltrate, abscess, and granuloma formation. Fibrosis is common .
Perifolliculitis capitis abscedens et suffodiens can be confused with other inflammatory conditions of the scalp including:
Perifolliculitis capitis abscedens et suffodiens is often chronic and difficult to treat [1,3].
Drugs used to treat perifolliculitis capitis abscedens et suffodiens include:
Interventional procedures for perifolliculitis capitis abscedens et suffodiens include:
Perifolliculitis capitis abscedens et suffodiens usually follows a chronic course with variable relapses [2,3]. The subsequent scarring alopecia results in permanent, patchy hair loss .
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