Dermatitis Cruris Pustulosa et Atrophicans: Scarring Alopecia Beyond Scalp Hair

Abstract

Dermatitis Cruris Pustulosa et Atrophicans (DCPA) was first described in 1952 in Nigeria and is nowadays regarded as a type of chronic folliculitis of tropical areas. It is often limited to the lower limbs of young adults, mostly in the second to third decades, with a unique clinical picture characterized by chronicity, relentless progression, therapy refractoriness, and permanent cicatricial changes. Trauma, occlusion, and microorganism selection contribute for its etiopathogenesis, which is deemed multifactorial but still incompletely understood. Despite its conspicuous clinical features, awareness of DCPA is apparently low, hence probably overlooked. We herein summarize the current state of knowledge regarding this distinct entity, and further present the first report in a patient from Bangladesh, and concurrently the first in Europe. Paucity of data, and unraveled definite etiology and treatment, highlight the need for further studies.

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.…”

“…(Figure 1e,f) DCPA is uniquely localised to the shin, with rare occurrences on the forearms, trunk, and pubic area, exhibiting a preference for areas with terminal hairs. [1][2][3] Recurrent symmetric follicular pustules at the initial phase eventually progress to alopecia and atrophy of the affected area. Although characteristic, diagnosis can be challenging due to its rarity and resemblance to folliculitis of other aetiologies.…”