Dermatitis cruris pustulosa et atrophicans

Abstract

Dermatitis cruris pustulosa et atrophicans (DCPA) is a distinctive type of chronic superficial folliculitis, primarily affecting the lower limbs. It is characterized by symmetrical follicular pustules of both legs, with cutaneous edema, resulting in alopecia, atrophy and scarring. It was first described by Clarke, from West Nigeria, in 1952 and well illustrated in his book "Skin diseases in the African," under the initial label of "Nigerian shin disease." Subsequently, it was described in India as well, in 1964, and continues to be a problem in dermatology clinics across the country. It is predominantly a disease of men and has a high prevalence in some geographical regions; up to 3-4% in Madras, South India. Some unique features that distinguish DCPA from banal pustular folliculitis include its peculiar localization to the legs, extreme chronicity, resistance to therapy and inevitable alopecia and atrophy of the involved skin, with little postinflammatory hyper- or hypopigmentation. Further, even in the presence of extensive lesions, there are no systemic features. Coagulase-positive Staphylococcus aureus is known to have a role in the etiology of DCPA, but the exact etiopathogenesis still needs to be elucidated. Immunological postulates such as hypergammaglobulinemia have been put forward to explain the chronicity of the condition. A number of therapeutic agents have been tried in various studies, including cotrimoxazole, psoralen with ultraviolet A (PUVA) therapy, ciprofloxacin, pentoxifylline, rifampicin, dapsone, minocycline and mupirocin (topical) with variable success rates. Although a well-recognized entity in dermatology clinics in tropical countries, DCPA has received little attention in the dermatological literature and has only a few studies to its credit. Its unique clinical picture, unclear etiopathogenesis and resistance to therapy afford a vast scope for further investigation and study.

Dermoscopic clues of dermatitis cruris pustulosa et atrophicans: A distinct folliculitis in dark skin phototypes

“…4 Specifically, the loss of hair follicular and eccrine openings and presence of hair casts as seen in our patient are more indicative of DCPA. 3,5 Exaggerated or discontinuous honey comb pigmentation and loss of normal skin furrows as was seen in our patient are nonspecific findings, and may be observed in other chronic inflammatory conditions in the dark skin. 6 Despite its rarity, further research is required, involving a larger sample of DCPA cases, to investigate the robustness of these features in distinguishing DCPA from other forms of folliculitis.…”

Skin Care Habits of Patients with Eczema at Kiambu Level 5 Hospital, Kiambu County, Kenya: A Retrospective Cross-sectional Study

“…21 It is also important to note that the use of petrolatum products, which is common in our set up, can also contribute to the development of acneiform rashes. 22 In the current study, 1 patient was routinely using a topical corticosteroid. This points to misuse of topical corticosteroids and warrants further investigation.…”

Isolated leg hair involvement in lichen planopilaris

“…Initial pruritic lesions were patchy and distributed over the distal part of both legs and gradually extended proximally up to the lower thigh level. He denied significant chronic pustular lesions over the legs suggestive of DCPA 4 . But for the past two years there was no significant progression of the cutaneous lesions but on and off few itchy skin lesions occurred continuously.…”