The clinicopathological spectrum of preclinical folliculitis keloidalis with correlation to its dermoscopic features: a cross‐sectional analytical study

Abstract

BackgroundFolliculitis keloidalis (FK) is a chronic hair disorder commonly affecting males with afro‐textured hair. It typically affects the nuchal area, but disease may also occur at extra‐nuchal sites. Few studies have investigated the histopathological aspects of preclinical FK. In addition to the histopathology of preclinical FK, this article is the first to describe the dermoscopic features of preclinical FK at extra‐nuchal sites.Materials and methodsThis study was conducted in a tertiary dermatological clinic. Twenty‐eight patients with a clinical diagnosis of FK were prospectively enrolled from 2014 to 2016. Dermoscopy was used to identify features that were not evident with the naked eye (preclinical). These sites were subsequently biopsied. The clinical, dermoscopic, and histopathological features of these preclinical areas are described and correlated.ResultsMost patients suffered a chronic disease course (mean: 7.6 years) with 57.1% (n = 16) displaying extra‐nuchal involvement. Dermoscopy‐guided biopsy of preclinical lesions displayed perivascular dermatitis (82.1%), folliculocentric inflammation (46.3%), and fibrosis (64.3%). Novel dermoscopic findings were perifollicular scale, perifollicular erythema and pink‐white areas. The perifollicular scale was associated with fibrosis on histopathology (P < 0.05).ConclusionsThis article lends further evidence for the existence of preclinical FK and describes its histological features. For the first time, it describes the dermoscopic features of preclinical FK. Dermoscopy may therefore be a useful tool to assess disease progression and treatment response.

Acne Keloidalis Nuchae in a Caucasian Non-Hispanic Woman With Metabolic Syndrome and Autoimmune Thyroiditis: A Case Report

“…The histological features described in AKN include folliculocentric inflammation (folliculitis and perifolliculitis), dilatation of the follicular infundibulum with follicular keratin plugs, follicular and perifollicular fibrosis and destruction of adnexal structures in the form of absence of sebaceous glands [ 7 , 17 ].…”