Disseminate and recurrent infundibulofolliculitis

Abstract

Three patients, one female and two males, aged 18, 45, and 25 years, respectively, presented with the complaint of skin-colored papules interspersed with pustular lesions over the anterior and lateral aspect of the neck and upper chest for 2, 8, and 6 months, respectively. Histopathologically, mononuclear cell infiltrate centered over the infundibulum of the hair follicle was seen which confirmed the diagnosis of disseminate and recurrent infundibulofolliculitis. We report this case due to its rarity, especially in the Indian population in which less than five case reports have been published. We also report a specific pattern of lesions along the neck skin creases which can serve as an aid to increase the index of suspicion for diagnosing this entity.

Transfollicular elimination of sebaceous glands in a patient with disseminate and recurrent infundibulofolliculitis

“…Other less commonly reported presentations include a linear distribution of papules along neck creases. 2 Histological examination revealing chronic perifollicular inflammation in association with typical papule distribution allows for a diagnosis of DRIF. Common symptoms include pruritus, which can be exacerbated in hot climates and may be significant to the degree of self-excoriation, but papules may also be asymptomatic.…”

“…Follicular eczema is characterized by inflammatory infiltrate not limited to the infundibulum of the hair follicle. 2 Keratosis pilaris is clinically significant for hyperkeratinization. 2 Lesions may be differentiated from truncal acne vulgaris by histopathology revealing follicular dilation, increased sebum production, and accumulation of keratin.…”

“…2 Keratosis pilaris is clinically significant for hyperkeratinization. 2 Lesions may be differentiated from truncal acne vulgaris by histopathology revealing follicular dilation, increased sebum production, and accumulation of keratin. 4 DRIF has been associated with other dermatologic conditions such as hidradenitis suppurativa, a chronic inflammatory disease of the pilosebaceous unit, especially in patients with trisomy 21.…”

“…5 There is no established treatment for DRIF, and most treatment regimens are anecdotal. 2 Topical steroids have largely been ineffective, a feature that distinguishes DRIF from atopic dermatitis. 6 Psoralen and long-wave ultraviolet radiation therapy were effective in one reported case.…”

“…Other less common findings include spongiosis, follicular dilatation, fibrinoid necrosis around the follicle, and the presence of melanophages. 2 We report a case of DRIF complicated by transfollicular elimination of the sebaceous unit. This additional finding of DRIF has rarely been reported in the literature.…”