38- Folliculitis and other follicular disorders Flashcards
What are the histological findings of folliculitis?
- perifollicular infiltrate of lymphocytes, neutrophils and macrophages.
What skin disorders are exacerbated by occlusions?
- folliculitis
- Grover disease
- miliaria rubra
- cutaneous candidiasis
What are the 3 major forms eosinophilic folliculitis?
- Ofuji disease (eosinophilic pustular folliculitis).
- immunosuppression associated eosinophilic pustular folliculitis
- eosinophilic pustular folliculitis of infancy.
How does eosinphilic pustular folliculitis present?
- recurrent episodes of eruptive intensely pruritis pustules.
- Occurs on acne-prone areas.
What are the histological features of eosinophilic folliculitis?
- spongiosis around follicles
- exocytosis of lymphocytes and eosinophils in the follicular epithelium
How is eosinophilic folluculitis treated?
- topical corticosteroids
- tacrolimus ointment
- oral antihistamines
indomethacin 50mg/day
UVB
oral minocycline
oral dapsone 100 - 200 mg/day for over 2 weeks)
CsA for patients with refractory disease.
How does immunosupression-assocated eosinophilic pustular folliculitis differ from eosinophilic folliculitis?
- immunosupression-associated eosinophilic pustular folliculitis is associated with Aids, lmphoma, CLL, acute myelogenous leukemia and other myeloproliferative disorders.
- The pustules are not large coalescent pustules or figurate.
- lesions more peristant
what differential diagnosis would you consider in patient with HIV who have immunosupressive eosinophilic pustular folliculitis?
- demodex
- folliuclitis
- HIV associated
- pruritic papular
- eruption
- papular dermaitis
- arthropod bites
- dermal hypersensitivity reaction
what is the treatment ladder for immunosupression-induced eosinphilic pustular folliculitis?
- treat HIV infection
- (if there is an immune reaction inflammatory syndrome then continue the HARRT until the lesions subside)
- topical corticosteroids
-nbUVB
tacrolimus, - topical permethrin
- oral itraconazole
-oral metronidazole
-oral antibiotics
what are the clinical features of eosinophilic pustular folliculitis of infancy?
- puritic follicular-based pustules and vesiculopustules with an erythematous rim on the scalp. The neck, face and trunk can oft be involved.
- cyclical course
- resolve by the age of 3 years.
what are the differential diagnosis of eosinophilic pustular folliculitis of infancy.
- erythema toxicum neonatorum
- transient neonatal pustular melanosis
- acropustulosis of infancy
- scabies
- Langerhans cell histiocytosis
What are the key features of phrynoderma?
” toad skin’
- follicular papules which are of various sizes with conical keratotic plugs over the thighs and upper forearms.
- may spread to invovle the extensor surfaces of the extremities and the abdomen, back and buttocks.
which nuceotide polymhorphism is an additional risk factor for pseudofolliculitis barbae?
1A a-helical subdomain of the hair follicle
What is the treatment for psuedofolliculitis barbae
- stop shaving - for 6-12 months in severe cases.
- If shaving is required then shave in the direction of hair growth
- use sharp razors and do shorter strokes
- remove pre-existing hair with hair clippers.
- ward compresses to release hairs
for mild to moderate pseudo folliculitis barbae the patient can use alpha hydroxy acids, benzyl peroxide.
what is the follicuar occusion tetrad?
- acne conglobata
- hidradenitis suppurativa
- dissecting ceululitis of the scal
