Perifolliculitis capitis abscedens et suffodiens

Ljubojević, Suzana; Pašić, Aida; Lipozenčić, Jasna; Skerlev, Mihael

doi:10.1111/j.1468-3083.2005.01215.x

Cited by 34 publications

(29 citation statements)

References 11 publications

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“…It is a disease of unknown aetiology that mainly affects young Afro-American males (3,4). While the disease has been observed in Caucasian women in the age range 20-40 years (4,5), to the best of our knowledge this is the first report of PCAS in an elderly Caucasian woman. The diagnosis was made on the basis of clinical and histopathological characteristics and after excluding other possible differential diagnostic considerations.…”

Section: Discussionmentioning

confidence: 81%

“…Draining sinuses develop in later lesions going along with a destruction of follicles. Both direct immunofiuorescence and microbiological examinations are negative (3,4).…”

Section: Discussionmentioning

confidence: 98%

“…The disease occurs most often on the vertex and occipital region (4,5). The disease is usually chronic, but may wax and wane with periods of inactivity.…”

Section: Discussionmentioning

confidence: 99%

“…Rarely squamous cell carcinoma or secondary amyloidosis can develop in chronic infiammatory skin lesions. PCAS is also associated with acne inversa (3)(4)(5)(6).…”

Section: Discussionmentioning

confidence: 99%

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New Approach in Combined Therapy of Perifolliculitis Capitis Abscedens et Suffodiens

Jacobs¹,

Metzler²,

Kubiak³

et al. 2011

Acta Derm Venerol

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PerifoIIiculitis capitis abscedens et suffodiens (PCAS)is a rare scalp disease seen mostly in young males of Afi-o-American descent. The disease is characterized by perifollicular pustules, suppurative nodules and fluctuating abscesses, as well as by intercommunicating sinus tracts on the scalp. We report here an elderly Caucasian woman who fialfilled the clinical and histological criteria for diagnosis of PCAS.The patient was treated with initial prednisolone, systemic acitretin, topical tacrolimus and oral zinc. After 6 months, her condition was stable. CASE REPORTAn 86-year-old woman reported having had purulent scalp lesions for approximately one year. She denied trauma or a preceding herpes zoster. Topical corticosteroids, as well as systemic amoxicillin/clavulanic acid, produced no improvement. A large draining boggy mass evolved on her occiput.Clinically, a 5 x 5 cm weeping, ulcerated nodule, with a raised border and numerous sinus tracts, was seen (Fig. lA). In addition, pustules were scattered over her scalp; some of which had evolved into fluctuant nodules with overlying alopecia.Laboratory results showed a leukocyte count of 10.7/nl (normal range 4.0-10.0/nl) and a C-reactive protein concentration of 2.8 mg/dl (normal: <0.5 mg/dl). In addition, the hlood level of zinc was slightly decreased (8.9 |imol/l; normal 9.2-18.4 \xmo\l\). The remaining laboratory parameters were within the normal range.A search for circulating autoantihodies specific for pemphigus and pemphigoid hy ELISA was negative. The virus-specific antihody counts for varicella-zoster and herpes simplex virus were IgG positive and IgM negative. PCR failed to detect Treponema pallidum, Bartonella, Mycoplasma and Mycobacteria.A skin hiopsy of the occipital region showed dissecting dermatitis with ahscess formation (Fig. 2). The dermis was dominated hy a neutrophilic inflammatory infiltrate. Terminal hair shafts were variably destroyed and entered into a sinus tract. In the upper dermis there was a suppurative inflammation with abscess material and hair shaft fragments being discharged via a draining sinus. Periodic acid-Schiff (PAS) staining for fungi, as well as immunohistochemical staining with anti-Mycohacterium hovis (BCG) and for T. pallidum was negative. Direct immunofluorescence of the perilesional scalp skin was negative.Microbiological examinations failed to identify pathogenic organisms.Following the diagnosis of a PCAS, the patient was treated with 10 mg acitretin and 30 mg prednisolone daily as an inpatient. The prednisolone was reduced to 5 mg per day during the course of treatment. Because of the decreased level of zinc, 100 mg zinc aspartate was given daily. In addition, topical glucocorticoids and tacrolimus 0.1% were alternated.This regimen produced almost total healing within 11 days (Fig. IB). The systemic corticosteroids were further tapered and the topical corticosteroids were stopped.Six months after discharge the patient's skin condition was Stahle on a regimen of 10 mg acitretin and 100 mg zinc aspartate daily, supple...

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Section: Discussionmentioning

confidence: 81%

“…Draining sinuses develop in later lesions going along with a destruction of follicles. Both direct immunofiuorescence and microbiological examinations are negative (3,4).…”

Section: Discussionmentioning

confidence: 98%

“…The disease occurs most often on the vertex and occipital region (4,5). The disease is usually chronic, but may wax and wane with periods of inactivity.…”

Section: Discussionmentioning

confidence: 99%

“…Rarely squamous cell carcinoma or secondary amyloidosis can develop in chronic infiammatory skin lesions. PCAS is also associated with acne inversa (3)(4)(5)(6).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

New Approach in Combined Therapy of Perifolliculitis Capitis Abscedens et Suffodiens

Jacobs¹,

Metzler²,

Kubiak³

et al. 2011

Acta Derm Venerol

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“…Perifolliculitis capitis abscedens et suffodiens (PCAS), a rare and severe progressive dissecting cellulitis or folliculitis of the scalp, presents with purulent-draining painful nodules, burrowing connecting tracts and cicatricial alopecia [11]. PCAS may affect large areas or even the whole scalp, producing multiple areas of baldness; sonography shows debris-filled fluid collections and/or abscesses with multiple interconnecting hypoechoic fistulous tracts that reach the hair bulb, causing follicular swelling ( Figure 12).…”

Section: Perifolliculitis Capitis Abscedens Et Suffodiensmentioning

confidence: 99%

Sonography in pathologies of scalp and hair

Wortsman¹,

Wortsman²,

Matsuoka³

et al. 2012

BJR

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ABSTRACT. Disorders of the scalp often result in severe cosmetic interference with quality of life, creating the need for optimal medical surveillance. We tested the latest generation of ultrasound machines in patients with scalp pathology and prepared a cross-sectional library encompassing a wide assortment of conditions. Normative data on the sonographic anatomy of scalp and human hair, and important methodological considerations, are also included. To improve the medical approach to diseases of the scalp, we evaluated colour Doppler ultrasound, a technique already applied to the study of localised lesions of the skin [2]. We screened 12 461 ultrasound examinations performed over the past 8 years at a national skin sonography referral centre, and selected 221 patients (168 male, 53 female) with scalp lesions. Sonograms were also performed on 33 healthy volunteers (31 male, 2 female). We then prepared a pictorial presentation highlighting sonographic characteristics of scalp skin, scalp hair and eyelashes, and archetypal scalp pathology

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3 Cases of Dissecting Cellulitis of the Scalp Treated With Adalimumab

Navarini¹,

Trüeb²

2010

Arch Dermatol

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Background: Dissecting cellulitis of the scalp (DCS) is a chronic inflammatory disease of scalp hair follicles manifesting as multiple painful nodules and abscesses that interconnect via sinus tracts. The disease tends to run a progressive course that eventually results in scarring alopecia. The condition is thought to represent a follicular occlusion disorder. Sebaceous and keratinous material within dilated pilosebaceous units accumulates until follicles burst, with subsequent neutrophilic inflammatory reaction and abscess formation. Treatment remains unsatisfactory. While oral antibiotics, intralesional corticosteroids, isotretinoin, or dapsone are insufficient, in this case series the inflammation responsible for scarifying tissue destruction was directly targeted by means of the tumor necrosis factor antagonist adalimumab. Observation: Clinical signs of inflammation as well as burden of disease measured by a score of 0 to 10 (PϽ.04) was reduced rapidly by adalimumab. Histopathologic characteristics demonstrated marked improvement of inflammation, despite persistence of underlying structural disease. Relapse was observed following discontinuation of adalimumab. Conclusions: Adalimumab is effective for treatment of DCS. Relapse on discontinuation of therapy can be expected depending on persisting structural disease. Continuous treatment or combined surgical resection of involved areas could be necessary for definitive resolution of disease.

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Perifolliculitis capitis abscedens et suffodiens

Cited by 34 publications

References 11 publications

New Approach in Combined Therapy of Perifolliculitis Capitis Abscedens et Suffodiens

New Approach in Combined Therapy of Perifolliculitis Capitis Abscedens et Suffodiens

Sonography in pathologies of scalp and hair

3 Cases of Dissecting Cellulitis of the Scalp Treated With Adalimumab

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