Tufted Hair Folliculitis

Diagnosis: Tufted Hair Folliculitis

tufts of hairs that appear to emerge from a single follicular orifice in a doll s hair pattern and areas of scarring alopecia, with complete loss of follicles

Clinical Presentation

tufts of hairs that appear to emerge from a single follicular orifice in a doll s hair pattern and areas of scarring alopecia, with complete loss of follicles

Clinical History

Submitted by Alaa Saad. Originally posted August 31, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Acne vulgaris • Pseudofolliculitis barbae • Hot tub folliculitis (Pseudomonas) • Pityrosporum (Malassezia) folliculitis • Eosinophilic folliculitis (HIV-associated) • Keratosis pilaris • Herpes simplex

Key Learnings

• Most common cause is S. aureus; consider MRSA in recurrent/treatment-resistant cases • Pityrosporum folliculitis: pruritic, monomorphic papules/pustules on trunk — often misdiagnosed as acne • Hot tub folliculitis (Pseudomonas aeruginosa): self-limited, 1-3 days after exposure • Gram-negative folliculitis: consider in acne patients on prolonged antibiotics • Eosinophilic folliculitis: think HIV/immunosuppression (CD4 <300) • Demodex folliculitis: peri-oral/peri-ocular, consider in rosacea-resistant cases

Tags: tufted, hair, folliculitis, alaa saad