Report of a patient with acne conglobata and perifolliculitis capitis abscedens et suffodiens / Informe de un paciente con acné conglobata y perifolliculitis capitis abscedens et suffodiens

Perifoliculitis capitis abscedens et suffodiens, dissecting folliculitis, dissecting cellulitis, or Hoffman disease is a rare, inflammatory and chronic condition, which affects the scalp of young black men, mainly characterized by the appearance of nodules and abscesses that drain purulent material with fistulas and pathways, leading ultimately to scarring alopecia. At present, this condition is defined as a primary disorder of follicular keratinization, being part of the triad or tetrad of follicular occlusion. One third of the cases are associated with acne conglobata as a primary event. Management, frustrating for many years, is promising with the successful use of isotretinoin and a combination of medications that intervene each of its physiopathological principles.

Perifoliculitis capitis abscedens et suffodiens, foliculitis disecante, celulitis disecante o enfermedad de Hoffman, es una condición inflamatoria rara, crónica, que afecta el escalpo de hombres jóvenes sobre todo de raza negra, caracterizada por aparición de nódulos y abscesos que drenan material purulento con formación de fístulas y trayectos, conduciendo finalmente a alopecia cicatrizal. En la actualidad se entiende esta entidad como un trastorno primario de la queratinización folicular, haciendo parte de la tríada de oclusión folicular, consistente en la presencia de 3 ó 4 de las siguientes entidades: acné conglobata, perifoliculitis capitis abscedens et suffodiens, hidradenitis supurativa y quiste pilonidal. La tercera parte de los casos se asocia con acné conglobata como evento primario. Su manejo, frustrante durante muchos años, tiene nuevas esperanzas con el uso exitoso de isotretinoína y combinación de fármacos que intervienen cada uno de sus principios fisiopatológicos.

Perifolliculitis Capitis Abscedens et Suffodiens Successfully Treated with Isotretinoin / 대한피부과학회지

Perifolliculitis capitis abscedens et suffodiens is a rare chronic recalcitrant follicular disorder which clinically presents itself as pulstules, nodules, intercommunicating abscess and sinuses that leave atrophic, hypertrophic or keloidal scars. Although the etiology of this of condition is unknown, its association with acne conglobata and hidradenitis suppurativa, collectively termed the follicular occlusion triad, suggest a cammon basic pathogenic mechanism of follicular retention. The therapeutic problem is reflected in the variety of therapies that have been tried with varying degrees of success. We report a case of a 34-year-old man who showed a patch of alopecia on the vertex of his scalp. Clinically, the scalp showed multiple soft fluctuant elevated nodules with nonscarring alopecic patches. We performed a treatment with isotretinoin(13-cis-retinoic acid) during 6 months. The patients clinical appearance was much improved and local recurrence and hair loss have not been observed to date.

A Case of Perifolliculitis Capitis Abscedens et Suffodience Treated with 13 - cis - Retinoic Acid / 대한피부과학회지

We reported a case of 22 years old male with perifolliculitis capitis abscedens et suffodiens. He had multiple fistular tracts, abscess, and cicatrized alopecia on the vertex and occiput. Compressing the abscess lesion, pus discharge was shown. Also he had acne conglobata and acne vulgaris on the face and nuchal area. On the bacterial culture, coagulase positive Staphylococcus aureus was isolated. These lesions were persistent in spite of frequent incision and drainage and antibiotic therapy. Considering it having a pathogenesis like acne conglobata, we tried him 13-cis-retinoic acid that had good effect in the treatment of cystic or conglobate acne. Three months after treatment, the lesions disappeared completely.