Friday, October 28, 2016

Chronic Localized Folliculitis

The patient is a healthy 28 yo man with a five year history of erythematous papules and pustules on the central upper chest.  No improvement over the past few years.

O/E:  There are erythematous crusted papules and pustules mid upper chest.  No other cutaneous lesions.

Clinical Photos:
Path:  4 mm punch bx x 2: Both specimens show a dense perifollicular neutrophilic iinfiltrate forming abscesses and infiltrating follicular epithelium with admixed lymphocytes, plasma cells and histiocytes.  GMS and PAS and gram stain negative.
Deon Wolpowitz, M.D. of B.U. Skin Pathology provided these impressive microscopic photographs.


Lab:  Two bacterial cultures taken from a pustules a year apart show only coagulase negative staph. 

Diagnosis: Chronic Localized Folliculitis.  Simplistically, I am thinking about Majocci's granuloma or an atypical form of acne.

The patient is reluctant to try isotretinoin or systemic antibiotics.  He is a healthy person in all other respects and has fears about messing with is microbiome and has read about isotretinoin and is worried.



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3 comments:

  1. Humane Medicine HuiOctober 28, 2016

    from Khalifa Sharquie (Baghdad): "This is chronic folliculitis which should respond quickly to Septrin tag 2tab twice a day for two weeks then 2tah for at least 2 months together with topical dalacin c lotion and there is no need at all to give isotretinoin

    ReplyDelete
  2. Henry FoongOctober 28, 2016

    The clinical and histological findings do not support diagnosis of malassezia folliculitis ( a.k.a pitysporum folliculitis). Oral minocycline once daily is quite effective for truncal acne together with topical sulphur 3% in calamine lotion. Beware of steroid induced folliculitis in male body builders.

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  3. Dr. Stephen StoneOctober 29, 2016

    Agree with Henry. Could also use benzoyl peroxide topically.

    ReplyDelete

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