Scar sarcoidosis in pseudofolliculitis barbae

A man with hilar adenopathy had smooth firm purplish papules (lupus pernio) on his face and pseudofolliculitis barbae (PFB) in his beard area. Biopsies of papules of both the lupus pernio and the PFB revealed non-caseating granulomas consistent with sarcoidosis. This is the first case report of sarcoidosis infiltrating lesions of PFB and the first of lupus pernio co-existing with scar sarcoidosis. In persons with suspected sarcoidosis, enlarged lesions of PFB are sites suitable for confirmatory biopsy. In addition, persons who develop keloid-like papules within their PFB may be providing an early cutaneous clue to undiagnosed systemic sarcoidosis.

Human immunodeficiency virus-associated eosinophilic folliculitis. A unique dermatosis associated with advanced human immunodeficiency virus infection

We studied 13 patients with human immunodeficiency virus (HIV) infection and a chronic pruritic folliculitis that was unresponsive to systemic treatment with bactericidal anti-staphylococcal antibiotics. The skin eruption was characterized by multiple urticarial follicular papules scattered on the trunk (100%), the head and neck (85%), and the proximal aspect of the extremities (62%). Absolute peripheral eosinophil counts were increased in six of 13 patients; a relative peripheral eosinophilia was present in 10 of 13 patients. Serum IgE levels were elevated in all seven patients tested (range, 88 to 9050 IU). Histopathologic features included a folliculitis with eosinophils. Pathogenic bacteria were not consistently found by routine bacterial skin cultures, cultures of skin biopsy specimens, or histopathologic evaluation. CD4 counts were decreased in all of the 12 patients tested (less than 300 cells per cubic millimeter) and were below 250 cells per cubic millimeter in 10 patients. A clinical response was noted to astemizole, to ultraviolet light in the B range, and to topical clobetasol propionate. These observations demonstrate that HIV-associated eosinophilic folliculitis is a unique HIV-related cutaneous disorder that is characterized by a culture-negative, chronic, pruritic folliculitis and a characteristic histopathologic picture. Of special importance, because it is associated with CD4 counts of less than 250 to 300 cells per cubic millimeter, eosinophilic folliculitis appears to be an important clinical marker of HIV infection and, particularly, of patients at increased risk of developing opportunistic infections. We suggest that the term eosinophilic pustular folliculitis (Ofuji's disease), previously used to describe this dermatosis in HIV-infected patients, should be discarded.

Follicular impetigo as presenting sign of systemic lupus erythematosus

A patient with an unusual form of follicular impetigo, who later developed classical systemic lupus erythematosus (SLE) is described. When she had pyoderma, direct immunofluorescence and serology already suggested a connective tissue disease. Pyoderma could have been the presenting manifestation of SLE.

Cutaneous manifestations and impaired chemotaxis of polymorphonuclear leukocytes associated with Kartagener's syndrome

Persistent deep-seated folliculitis and impaired chemotaxis are described in a 24-year-old woman with situs inversus, bronchitis and sinusitis, i.e. the three characteristics of Kartagener's syndrome. While patients with chemotactic defects not associated with the syndrome often suffer from skin infections, to the best of our knowledge this is the first report of a Kartagener patient with cutaneous manifestations.

Dissecting cellulitis of the scalp in 2 girls

Two girls with dissecting cellulitis of the scalp are described. In one Pseudomonas aeruginosa was isolated from the sinus discharge. Both patients were controlled with prolonged antibiotic therapy and periodic aspiration of the fluctuant lesions. Role of infection in perpetuating the condition is highlighted.

Pruritic folliculitis of pregnancy

Pruritic folliculitis of pregnancy may appear any time after the fourth month of gestation. This distinct dermatosis is characterized by pruritus and small, follicle-centered, erythematous papules that may be excoriated or may have the appearance of small pustules. Distribution is variable, although all reported cases have included the abdomen. There is an absence of systemic maternal or fetal toxicity, and the condition resolves spontaneously after delivery. The cause of this dermatosis is unknown.

Severe perifolliculitis capitis with osteomyelitis

This report describes a severe case of perifolliculitis capitis with the rare complication of skull osteomyelitis, a combination not previously reported. The patient demonstrated the typical features of perifolliculitis capitis, namely, rubbery, hard, elevated nodules involving almost the entire scalp with multiple deep-seated abscesses. Bone was exposed in two areas and the diagnosis of skull osteomyelitis was confirmed by skull x-ray films and bone biopsy specimens, which grew Staphylococcus aureus. The patient was treated with enteral hyperalimentation, intravenous antibiotics, and multiple debridements of the scalp, including the involved periosteum and outer cortex of the exposed bone, followed by reconstruction with split-thickness skin grafts. A complete eradication of the disease with closure of all open wounds and clearance of osteomyelitis of the skull was achieved.

Eosinophilic pustular folliculitis in patients with acquired immunodeficiency syndrome. Report of three cases

Eosinophilic pustular folliculitis is a rare disease. Highly unusual is its occurrence in three patients with acquired immunodeficiency syndrome (AIDS), described herein. This association may be the result of immunologic aberrations that are described in AIDS and may represent an abnormal reaction to skin saprophytes and dermatophytes.

Pseudofolliculitis barbae with keloids

Pseudofolliculitis barbae is a common cutaneous infection occurring in the bearded area of the face of black men. The infection is caused by ingrown hairs that produce an inflammatory foreign body reaction characterized by papules and pustules at the point of hair penetration that may result in permanent scarring, usually in grooved patterns, and occasionally in keloids. The purpose of this article is to describe the successful treatment of a patient with pseudofolliculitis with keloids that was based on the pathophysiology of the disease and the biology of wound repair.

Perforating folliculitis in association with primary sclerosing cholangitis

Two patients with primary sclerosing cholangitis developed perforating lesions in the skin of the extremities. Clinically and histologically, the cutaneous condition showed the features of perforating folliculitis with superimposed lesions of prurigo nodularis. The course of the eruption paralleled the severity of the biliary disease. A theory of pathogenesis for the development of the perforating folliculitis in these patients is suggested. To the best of our knowledge, this is the first report of the coexistence of both conditions.

Influence of age of onset and patient's sex on the prevalence and severity of manifestations of Behçet's syndrome

Eye disease, arthritis, folliculitis, and thrombophlebitis were more common among males, and erythema nodosum among females, in 297 patients with Behćet syndrome (BS) at their first visit despite an identical disease duration. Younger males and females (age of onset 24 years or less) had a higher prevalence of eye disease and total clinical activity than did the older patients (age of onset 25 years or more). Among the 51 patients followed up for 52 months (SD 7 months) the total clinical activity became significantly less (p less than 0.05) in the whole group at the end of this period. This was particularly true for older females. While male sex and a younger age of onset are associated with more severe disease in BS, overall, the syndrome ran an improving or stable course over 4 1/2 years.

[Generalized perforating folliculitis in chronic kidney insufficiency]

A 24-year-old female patient is reported, in whom severe renal insufficiency following renal transplantation for Goodpasture's syndrome was associated with a persistent generalized perforating folliculitis of the trunk and extremities. In addition to the pathologic renal parameters a hypervitaminosis A was found. On the basis of this observation as well as similar recent reports in the literature it is suggested that a subset of an unusually extensive perforating folliculitis may occur with renal insufficiency and, albeit rare, represents a clinical marker for this associated condition.

Perforating folliculitis and psoriasis

A 51-year-old man with a 10-year history of psoriasis presented with coexistent perforating folliculitis. Several perforating lesions were located within psoriatic plaques. This case is instructive from several viewpoints: (1) it is the second case to appear in the literature, to our knowledge, describing the coexistence of these two conditions; (2) several of the larger lesions resolved during topical therapy with retinoic acid; (3) it demonstrates the histologic difficulties encountered in attempting to classify the major perforating diseases. Possible mechanisms for the development of perforating disease in this patient are discussed, as are the reasons for its apparent response to topical therapy.