[Case for diagnosis]

Keratosis follicularis spinulosa decalvans is a rare X-linked genodermatosis, characterized by follicular hyperkeratosis, photophobia, scarring alopecia of the scalp and eyebrows. A case of a 25 year old female with typical clinical picture and progression of this syndrome is described.

Familial keratosis follicularis spinulosa decalvans associated with woolly hair

Keratosis follicularis spinulosa decalvans (KFSD) is a rare inherited disorder of keratinization clinically characterized by diffuse follicular hyperkeratosis, progressive scarring alopecia of scalp, eyebrows and eyelashes, corneal dystrophy and photophobia. Woolly hair is a hereditary condition, transmitted as an autosomal dominant or recessive trait, usually seen in Caucasians at birth or shortly after, in which there are curly, thick, often heavily pigmented hairs. We report two cases, a son and his mother, in whom KFSD occurred in association with woolly hair. In addition, various dental anomalies, including agenesis, inclusions and teeth malformations, were present in the child. Interestingly, both patients simultaneously developed an inflammatory tinea capitis caused by Microsporum canis. To our knowledge, the association of KFSD with woolly hair has not been described. The dental anomalies found in the child are intriguing, as they have never been reported previously in patients with KFSD. Finally, the concomitant onset of inflammatory tinea capitis in both patients may be explained by the enhanced susceptibility to fungal infection in keratinizing disorders.

Folliculitis spinulosa decalvans: an uncommon entity within the keratosis pilaris atrophicans spectrum

Folliculitis spinulosa decalvans is an uncommon condition characterized by follicular hyperkeratosis, followed by scarring alopecia. We report a 12-year-old boy affected by keratotic papules of the scalp and keratosis pilaris of the limbs who developed erythema, pustules, and scale crusts on the scalp associated with scarring alopecia. Histologic examination showed follicular and interfollicular hyperkeratosis, follicular plugging, mild inflammation, and focal scarring. A transient remission of the inflammatory changes on the scalp was obtained after treatment with isotretinoin. The follicular spinulous hyperkeratosis persisted. A severe relapse of the scalp inflammation was observed during a 2-year follow-up.

Keratosis follicularis spinulosa decalvans and acne keloidalis nuchae

A 27-year-old man presented with a 10-year history of scarring alopecia on the vertex of the scalp associated with follicular crusting and pustule formation, and a papular eruption on the posterior neck. Additionally, there was keratosis pilaris on the cheeks, eyebrows and thighs. Histology from the vertex showed scarring with a mixed perifollicular inflammatory infiltrate and foci of acute suppurative folliculitis. With clinical correlation, the diagnosis of keratosis follicularis spinulosa decalvans and concurrent acne keloidalis nuchae was made. The association of keratosis follicularis spinulosa decalvans with acne keloidalis nuchae has not previously been described. The patient responded to treatment with oral isotretinoin 20 mg (0.25 mg/kg) daily for 12 months.

A case of atrophoderma vermiculatum responding to isotretinoin

Atrophoderma vermiculatum (AV) is a rare disorder leading to reticular or honeycomb scarring of the face and responding poorly to treatment. A case is now presented of the successful induction of remission in the inflammatory component of the disease following a prolonged course of isotretinoin; improvement was then maintained after cessation of the treatment. In severe cases of AV with significant scarring, a trial of isotretinoin therapy is thus worthwhile in an attempt to stop progression of the disease and improve its cosmetic appearance.