A Rare Form of Suppurating and Cicatrizing Disease of the Scalp

Abstract

of Physicians and Surgeons NEW YORK A chronic inflammatory disease of the scalp, primarily perifollicular, leading to suppuration and extensive undermining of the involved area, was given the name Perifolliculitis capitis abscedens et suffodiens by E. Hoffmann. He presented such a case before the Berlin Dermatological society, Nov. 12, 1907. Hokmann's patient, a man aged 25, had then been afflicted for a year, and showed "on the occiput many (about 20) nearly hazelnut sized, pale, hemispherical elevations, hairless or covered at the borders with sparse, short hair stumps, from which on pressure pus exuded and into whose fistulous openings the sound could be introduced up to 4 or 5 cm. Beside these closely crowded tumors with smooth, pale, grayish-red surfaces, which gave the scalp a rough, uneven, mammillated appearance, there were a few disseminated pustules and crusts, pierced by hairs, and isolated, small coin-sized, smooth scars. Healing resulted in further scar formation and was hastened by a 10 per cent, sulphur-zinc paste. Microscopically there was no fungus ; cultural investigation for sporotrichosis proved negative. There was, then, a suppurating folliculitis, undermining the scalp, with formation of fistulae and termination in cicatrizing alopecia." The American, and to the best of our knowledge, the British, French and Italian literature contains no record of this entity ; but in the German dermatologie publications we find that A. Ruete 1 has carefully described the disease in an article which deserves to be reviewed in detail. In the introduction he mentions the numerous processes leading to scarring of the scalp or to alopecia associated with scarring, touching on syphilis, tuberculosis, favus, lupus erythematosus and the innominate cicatricial alopecias of Besnier, which include folliculitis decalvans Read before the Section on Dermatology and Syphilology at the Seventy\x=req-\ Second Annual Session of the American Medical Association, Boston, June, 1921. 1. Ruete, A.: Ein Fall von Perifolliculitis capitis abscedens et suffodiens.

Scarring alopecia: A classification based on microscopic criteria

“…This pttstulofollictilar scarring alc:)pecia was termed perifolliculitis capitis abscedens et sulfbdiens by Hoffman in 1908 (34) and later renamed dissecting ceiiuiitis of the scalp (35). Dissecdng cellnlitis occurs most commonly in young adult black men.…”

Perifolliculitis capitis abscedens et suffodiens treatment with tumor necrosis factor inhibitors: A case report and review of published cases

“…Perifolliculitis capitis abscedens et suffodiens (PCAS) or dissecting cellulitis is a rare condition presenting deep follicular occlusions, follicular ruptures and follicular infections in the scalp area with unknown etiology, which consequently cause primary neutrophilic cicatricial alopecia by the repeated follicular inflammation. 1 PCAS is seen most commonly in darkskinned individuals. 2 PCAS, hidradenitis suppurativa (HS), acne conglobata and pilonidal cyst are members of the "follicular occlusion tetrad."…”

Hidradenitis suppurativa with perifolliculitis capitis abscedens et suffodiens successfully treated with a human anti‐tumour necrosis factor monoclonal antibody

“…Repeated follicular inflammation in PCAS leads to primary neutrophilic cicatricial alopecia. 3 The cutaneous changes seem to start around the hair follicles and involve activation of cells of the innate and adaptive immune systems. 1 Resident and migratory cells of the innate and adaptive immune systems secrete proinflammatory cytokines such as TNF, interleukin (IL)-1b and IL-17 to activate the tissue cells, further enhancing immune cell infiltration and inflammation.…”