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folliculitis_scalp

scalp folliculitis

introduction

  • scalp pustules are a relatively common problem and often recurrent
  • there are many causes and the various conditions can be divided in to those causing superficial pustules or vesicles vs those causing deeper granulomas

superficial folliculitis

  • vesicular or papulovesicular:
  • pustular:
    • acne vulgaris
    • bacterial folliculitis
      • most often caused by Staphylococcus aureus, streptococcus, proteus, pseudomonas or coliform bacilli
      • especially if hyperhidrosis, macerated skin, depilation, topical steroids, chemicals or immunocompromise eg. HIV / AIDS, diabetes mellitus
      • may become a deep furuncle or carbuncle
    • toxic erythema of the newborn
    • pruritic folliculitis of pregnancy
    • dermatophytes
      • Microsporous ringworm tinea of the scalp (great gray patch tinea)
        • large round patches with satellite patches, hairs break at 4-6mm, fluoresce under Wood's lamp
      • Trichophytic ringworm tinea of the scalp (black dots tinea)
        • multiple small alopecic areas with black dots of hair follicle broken at skin surface
    • candida
    • Pityrosporum
      • superficial pustulosis which most frequently affects the back and the upper part of the thorax
    • chemical or mechanical trauma
    • acneiform eruptions
    • pseudofolliculitis
      • mainly in black men when curly beard hairs are cut too short, they may curve back into the skin and cause inflammation
    • keratosis pilaris atrophicans
      • hair keratosis
      • pseudopelade
    • keratosis follicularis spinulosa decalvans
      • usually X-linked recessive, rarely AD 1)
      • causes cicatricial alopecia of the scalp and eyebrows during infancy or adolescence
    • lichen planopilaris
      • mainly women 30-60yrs old, mainly front or occipital
    • pityriasis rubra pilaris
      • generally accompanies or precedes seborrheic dermatitis of the scalp
      • yellow-orange erythematosquamous plaques, often developing on the scalp, with obvious islands of sparring and palmoplantar hyperkeratosis.
    • acne necrotica
      • mainly women and mainly on peripheral areas of scalp
    • eosinophilic pustular folliculitis (Ofuji’s syndrome)
      • recurrent episodes of eruptive sterile follicular papulopustules in seborrheic areas (including face, neck, trunk as well as scalp), accompanied by leukocytosis and eosinophilia on biopsy. Many cases have mild eosinophilia, mild rise in IgE and reduced IgG and IgA on blood tests.
      • classic form: more common in Japan; chronic and recurrent with individual lesions typically last more than 1-2 weeks, and relapse every 3-4 weeks but no systemic symptoms. 70-90% respond well to NSAIDs such as oral indomethacin (25–75 mg/day). Refractory cases may require UV Rx or otehr Rx.
      • immunosuppression-associated type of EPF - eg. HIV, leukaemia, etc
      • infantile form - most resolve by age 3yrs
      • in cases where the torso and palms are affected, consider L-tryptophan-induced form with eosinophilic-myalgia syndrome
      • medication induced EPF eg. allopurinol, timepidium bromide, carbamazepine, indeloxazine hydrochloride, minocycline, paroxetine, etizolam, maprotiline 2)
    • follicular mucinosis
      • follicular papules and indurated plaques associated with alopecia
      • accompanied with mycosis fungoides and angiolymphoid hyperplasia with eosinophilia, less frequently with chronic discoid lupus erythematosus and Goodpasture’s syndrome
    • follicular mycosis fungoides
      • infiltrated follicular papules located on the face, neck, trunk and extremities, and sometimes on the scalp
    • perifolliculitis capitis abscendens et suffodiens
      • severe destructive folliculitis with sinus tracts and fistulae leading to scarring alopecia
      • often part of the acne inversa spectrum
      • almost exclusively in young men
      • ?role of Gram negative infections
    • secondary syphilis (rare)
    • folliculitis decalvans (rare)
      • causes tufting of hair so it looks like a toothbrush and eventually scarring and cicatricial alopecia
    • genetic immunodeficiencies
      • recurrent and persistent pyoderma, folliculitis, keratitis, and atopic dermatitis with defective leukocyte and lymphocyte function and response to antihistamines (H1)3)

deep folliculitis generally with granulomas

  • acne vulgaris
  • acne inversa group of follicular occlusion conditions
    • acne conglobata
    • dissecting cellulitis of the scalp
    • hidradenitis suppurativa
      • rare familial form which affects the post-auricular region 4)
  • staph furuncle/carbuncle
  • tinea barbae
  • sycosis
  • favus
    • folliculitis caused by T. schoenleinii and is currently prevalent in Spain
  • kerion Celsi
    • starts as tinea tonsurans
  • demodicosis
    • excessive amount of Demodex mites
  • lupoid rosacea
  • acne conglobata
  • perforating folliculitis
  • halogens
  • acneiform syphilis
  • folliculitis sclerotisans nuchae (keloidal folliculitis)
    • mainly on the neck and mainly dark skinned males
folliculitis_scalp.txt · Last modified: 2019/07/13 17:08 by wh