Case of the Month
33-year-old African-American man presents with mildly pruritic papules on his chest and back x 2 years. The papules are distributed in a follicular manner. Here are photomicrographs (high and low power) of one of the lesions that I biopsied. Photo taken by Erick Jacobsen MD, dermatopathologist, with his dermatopathologic description to follow)
Histologic sections show a suppurative folliculitis with some follicular edema and inflammation involving the follicular infundibulum. There is also keratin debris and hemorrhage. The findings are those of a suppurative folliculitis. Although these findings are not specific, an infundibulofolliculitis is the reported histopathology of ……..(diagnosis to follow)
What's Your Diagnosis?
Diagnosis: Disseminate and Recurrent Infundibulofolliculitis (Hitch and Lund Disease)
“Disseminate and recurrent infundibulofolliculitis, consists of widespread discrete, pruritic, follicular papules that wax and wane, and [can] defy therapeutic intervention. Lesions show a predilection for the chest, back, and buttocks, [but may be widespread]. ……The differential diagnosis is broad: phrynoderma, keratosis pilaris, secondary syphilis, lichen nitidus, follicular atopic dermatitis, Darier’s and Kyrle’s diseases, and lichen planopilaris. Clinical and histologic features serve to distinguish the preceding entities from disseminate and recurrent infundibulofolliculitis.
The majority of patients reported to have this unusual disease are young blacks who are otherwise in good health. Several instances of an apparently identical disorder are noted, however, in whites”.
Treatment with topical steroids, isotretinoin and phototherapy, have all been reported to be helpful. In this particular case, I gave the patient Cerave Itch-Relief Moisturizing Lotion (1% Pramoxine Hydrochloride) and instructed him to use it BID, but especially after bathing and during periods of pruritic activity. At follow-up he said that this lotion gave him great improvement/relief when needed.
Reference: Atlas of Black Dermatology. Theodore Rosen M.D. and Sandy Martin, M.D.
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