Red nodule on the face with "spontaneous" regression

Abstract Pseudolymphomatous folliculitis is a rare entity included among the cutaneous pseudolymphomas. A 32-year-old man, with an unremarkable medical history, presented with a two-month history of an asymptomatic solitary nodule on his left cheek. Histopathological examination demonstrated a dense nodular and diffuse dermal lymphocytic infiltrate with numerous histiocytes and dendritic cells that surrounded hypertrophic hair follicles. Pseudolymphomatous folliculitis commonly presents in the fourth decade of life, with no sex predominance, as an asymptomatic, rapidly growing and solitary red dome-shaped nodule on the face. It has a benign clinical course as the lesions usually resolve with surgical excision or regress spontaneously after incisional biopsy. Although there is no report of pseudolymphomatous folliculitis progressing into lymphoma in the literature, follow-up of these patients is recommended.

Dermoscopy: a useful tool for assisting the diagnosis of Pseudomonas folliculitis

Abstract This report describes the usefulness of dermoscopy as a supportive diagnostic tool in a pseudomonas folliculitis case.

Pruritic folliculitis of pregnancy

Abstract Pruritic folliculitis of pregnancy is a rare disease of unknown etiology. It occcurs primarily during pregnancy, usually with spontaneous resolution postpartum. It is characterized by a benign dermatosis, with papular and pustular follicular lesions that first appear on the torso and occasionally spread throughout the body. We report the case of a patient in the 27th week of pregnancy, with a two-month evolution of pruritic and papular erythematous lesions on her lower back. Differential diagnosis includes other pregnancy-specific dermatoses: gestational pemphigoid, pruritic urticarial papules and plaques of pregnancy (PUPPP), prurigo of pregnancy, and (PUPPP) and prurigo of pregancy. Histopathological tests showed changes consistent with pruritic folliculitis of pregnancy. This case is relevant due to its rare nature and its clinical and histopathological characteristics.

Ofuji disease: a rare dermatosis and its challenging therapeutic approach

Abstract: Eosinophilic pustular folliculitis (EPF) or Ofuji disease is a rare dermatosis, prone to recurrence and chronicity. The peak incidence occurs in the third decade of life and its exact etiology remains unknown. Evidence suggests that the expression of adhesion molecules and the production of cytokines activate the follicular unit, but the stimulus that triggers these changes remains unclear. The three clinical variants reported in the literature include classic EPF, immunosuppression-associated EPF, and infancy-associated EPF. We report a case of eosinophilic pustular folliculitis with peculiar epidemiological characteristics, which represents a challenging therapeutic scenario.

Majocchi's granuloma - Case report

We report the case of a three-year-old child who, following long term treatment with topical corticosteroids and their associations for a case of ringworm on the face developed a form of folliculitis known as Majocchi's Granuloma. Treatment with oral Griseofulvin was successful.

Foliculitis necrotizante herpética / Necrotizing herpes folliculitis. Report of one case

Herpes folliculitis is a rare manifestation of herpes virus infection. It usually represents a diagnostic challenge, due to the absence of characteristic skin manifestations such as vesicles or pustules. The reported cases are mainly associated with varicella zoster virus (VZV) and less commonly with herpes simplex viruses (HSV-1 y HSV-2). We report a 51-year-old male with a relapsing non-Hodgkin Lymphoma under chemotherapy, with history of extensive follicular lesions lasting one month. The pathologic study of the lesions was consistent with necrotizing herpes folliculitis. The patient was treated with Valacyclovir, achieving remission of the lesions. The appearance of folliculitis, especially in an immunocompromised patient, should raise the suspicion of herpes virus infection. Polymerase chain reaction may help to elucidate the diagnosis when pathologic findings are non-specific.

Exuberant clinical presentation of probable Malassezia folliculitis in a young nonimmunosuppressed patient / Apresentação clinica exuberante de provável foliculite por Malassezia em jovem imunocompetente

Malassezia folliculitis is an inflammatory disorder observed in both immunocompetent and immunosuppressed patients. The authors describe an unusual and exuberant presumed case affecting the face, trunk and upper limbs of a 12-year-old nonimmunosuppressed patient. Although the agent was not identified by culture, the clinical and histopathological aspects plus the response to specific treatment support the diagnosis of Malassezia folliculitis. The only possible predisponent cause observed on the patient was greasy skin. Repetitive cultures were negative. Treatment with itraconazol promoted apparent cure, however, the patient relapsed twelve months later.

Foliculite por Malassezia é processo inflamatório observado em pacientes imunocompetentes e imunossuprimidos. Os autores relatam um provável caso exuberante e incomum comprometendo a face, tronco e membros superiores de paciente de 12 anos de idade, não imunossuprimido. Embora o agente não tenha sido cultivado, os achados clínicos e histopatológicos aliados à resposta terapêutica sugerem o diagnóstico de foliculite por Malassezia. A única possivel causa predisponente demonstrada no paciente foi a pele oleosa. Tentativas de cultivo do agente foram negativas. O tratamento com itraconazol promoveu cura aparente, entretanto, houve recaída após 12 meses.

Dermatoses neutrofílicas: parte II / Neutrophilic dermatoses: part II

Neste artigo são abordadas as dermatoses neutrofílicas, complementando o artigo anterior (parte I). São apresentadas e comentadas as seguintes dermatoses: pustulose subcórnea de Sneddon-Wilkinson, dermatite crural pustulosa e atrófica, pustulose exantemática generalizada aguda, acroder matite contínua de Hallopeau, pustulose palmoplantar, acropustulose infantil, bacteride pustular de Andrews e foliculite pustulosa eosinofílica. Uma breve revisão das dermatoses neutrofílicas em pacientes pediátricos também é realizada.

This article addresses neutrophilic dermatoses, thus complementing the previous article (part I). The following dermatoses are introduced and discussed: subcorneal pustular dermatosis (Sneddon-Wilkinson disease), dermatitis cruris pustulosa et atrophicans, acute generalized exanthematous pustulosis, continuous Hallopeau acrodermatitis, palmoplantar pustulosis, infantile acropustulosis, Andrews' pustular bacteride and eosinophilic pustular folliculitis. A brief review of neutrophilic dermatoses in pediatric patients is also conducted.

Primary cicatricial alopecias: a review of histopathologic findings in 38 patients from a clinical University Hospital in Sao Paulo, Brazil

BACKGROUND: Scarring alopecias are classified into primary and secondary types according to the initial site of inflammation. In primary scarring alopecias, the hair follicle is the main target of destruction; the term secondary cicatricial alopecia implies that follicular destruction is not the primary pathologic event. AIMS: To review the histopathologic diagnoses of cases of cicatricial alopecia in order to classify them according to the North American Hair Research Society. PATIENTS AND METHODS: Patients with biopsy specimens diagnosed as cicatricial alopecia seen from 2000 to 2005 at the Dermatologic Department of Hospital das Clinicas, São Paulo University Medical School had hematoxylin and eosin, Periodic acid-Schiff and Weigert stained slides reevaluated and sub-typed into different primary cicatricial alopecias. RESULTS: Thirty-eight cases of primary cicatricial alopecias were reclassified as: chronic cutaneous lupus (17), lichen planus pilaris (4), pseudopelade of Brocq (12), folliculitis decalvans (3), dissecting folliculitis (1), and non-specific scarring alopecia (1). In our cases, the methods employed allowed an accurate diagnosis in 12 of 13 cases (92.3 percent) previously classified as non-specific cicatricial alopecias. CONCLUSIONS: Even in the late, pauci or non-inflammatory phases, an approach with systematic evaluation of a constellation of criteria in routine hematoxylin and eosin stain, Periodic acid-Schiff and Weigert stain allowed for a more accurate diagnosis of cicatricial alopecias.

Disseminated nodular granulomatous perifolliculitis.

Nodular granulomatous perifolliculitis is a well-recognized infection of the dermal and subcutaneous tissue caused by dermatophytes, which normally do not invade beyond the epidermis. We report here one such case that occurred in an immunosuppressed individual. The patient was a 35-year-old farmer who presented with small pruritic eruption that had initially appeared on the lower leg and then had gradually spread to hair-bearing areas of the body, finally producing nodular and pustular inflammatory lesions with exacerbations and remissions. Fungal examination by direct potassium hydroxide mount and culture revealed Trichophyton rubrum. Granulomatous changes were seen on histopathological examination. The patient completely responded to systemic antifungal therapy.

Foliculitis pustulosa eosinofílica (enfermedad de Ofuji): presentación de 1 caso / Eosinophilic pustular folliculitis (Ofuji disease): a case presentation

Se presentó una paciente de 65 años, blanca, que desde aproximadamente un año y medio comenzó a padecer brotes recurrentes de lesiones eritematosas, pústulo papulosas, foliculares estériles con extensión periférica y aclaración central, con prurito localizado en la cara, tronco, extremidades, palmas de las manos y las plantas de los pies. Estas últimas fueron el primer signo de aparición de la enfermedad precediendo semanas o meses a las otras localizaciones. Durante ese período llevó numerosos tratamientos sin lograr mejoría. Por tal motivo se decidió su ingreso en este hospital donde se le realizó biopsia de piel, luego fue sometida a discusión por el colectivo de Dermatología y discusión clínico patológica con nuestro grupo básico de trabajo. El diagnóstico fue complejo, por presentar una patología no frecuente, foliculitis pustulosa eosinofílica (enfermedad de Ofuji), en su forma clásica, rara en el sexo femenino, asociada a una psoriasis.

A 65 years-old female Caucasian patient, who had suffered for one year and a half recurrent rashes of erythematous, pustular, follicular and sterile lesions with peripheral extension and central clearing in addition to itching in her face, trunk, limbs, palms and soles, was presented. The onset of the disease occured in the last two locations some weeks or months before affecting the others. During this period, a number of therapies were applied without any positive result. For these reasons, it was decided to refer the patient to the hospital where skin biopsy was performed, and the results were submitted for discussion to a Dermatology group and also for clinical-pathological discussion to our basic working team. The diagnosis was complex because she suffered from eosinophilic pustular folliculitis (Ofuji disease) in its classical form, a rare pathology in females and associated to psoriasis.

Acné y enfermedades afines: pseudofoliculitis de la barba: actualización / Pseudofolliculitis barbae: update

La pseudofoliculitis de la barba es una enfermedad inflamatoria crónica de la piel, potencialmente desfigurante y estresante, vista a menudo en la consulta dermatológica. Ocurren generalmente en personas con pelo rizado que se afeitan o depilan el área de la barba con frecuencia. Su etiología es multifactorial y se caracteriza por la presencia de pápulas y pústulas en el área de la barba, asociado en ocasiones a cicatrices queloídeas. Su manejo incluye el cese del afeitado, el uso de depilatorios, agentes tópicos , láser, y la modificación de las técnicas de afeitado.

Acné necrótico: foliculitis necrotizante linfocítica / Acne necrotica: necrotizing lymphocytic folliculitis

El acné necrótico varioliforme o foliculitis linfocítica necrotizante se caracteriza por lesiones papulosas y pápulo-pustulosas con centro umbilicado, deprimido, recubiertas por costras necróticas y adherentes que evolucionan hacia cicatrices de aspecto varioliforme. Se trata de un proceso inflamatorio crónico y recidivante de localización folicular y perifolicular, especialmente en el límite de la frente con el cuero cabelludo. Su fisiopatología es discutida, probablemente producida por fenómenos de sensibilización a antígenos microbianos del folículo piloso. Presentamos cinco casos con lesiones de acné necrótico. En la histopatología se observó una reacción liquenoide atípica, con activa participación de la interfase y queratinocitos necrobióticos llegando a producir en etapas tardías una extensa necrosis de todo el folículo. Sin embargo, en 3 pacientes las lesiones se localizaban además en la epidermis interanexial que mostraba áreas de necrosis. Se sugiere que el acné necrótico no es solamente una afección del folículo pilo-sebáceo sino de la epidermis alejada del folículo. La fisiopatología de este proceso está desencadenada por linfocitos T con función citotóxica. En algunas zonas se observa un infiltrado linfocitario denso que remeda un seudolinfoma, por lo que se plantea la asociación de otros fenómenos fisiopatológicos de naturaleza inmune. El acné necrótico es una respuesta inmune donde el queratinocito sería la célula "blanco". Sugerimos que esta célula puede estar modificada antigénicamente por la presencia de microbios, especialmente por estafilococos

Foliculitis por malassezia / Malassezia folliculitis

Son analizadas las características clínicas y datos epidemiológicos de quince enfermos que acusaban foliculitis por malassezia, observados en la ciudad de Santa Fe (Argentina). Se efectúa una revisión de los factores predisponentes y/o coadyuvantes para el desarrollo de esta enfermedad y se los compara con lo publicado por otros autores. La terapéutica instituida fue itraconazol oral, adicionada con lavados con champú de ketoconazol, logrando controlar la enfermedad. Se enfatiza la mayor frecuencia de casos de foliculitis por malassezia en zonas geográficas con climas cálidos y húmedos

Foliculitis pustulosa eosinofílica: presentación de cuatro casos y revisión de la literatura / Eosinophilic pustular folliculitis: presentation four cases and review of literature

La foliculitis pustulosa eosinofílica es una condición rara que está siendo declarada en pacientes HIV positivos de manera cada vez más frecuente. Generalmente, afecta a adultos y clínicamente se caracteriza por brotes recurrentes de papulopústulas estériles y pruriginosas agrupadas en forma anular y policíclica, afectando preferentemente áreas seborreicas. El examen histopatológico revela abscesos eosinofílicos. Presentamos 4 pacientes, 3 HIV positivos, con foliculitis pustulosa eosinofílica y revisamos la literatura

Tricofoliculoma: a propósito de un caso / Trichofolliculoma: apropos of 1 case

Los tumores anexiales generalmente se clasifican de acuerdo a la estructura de la cual presumiblemente derivan. El Tricofoliculoma se ubica entre los tumores bien diferenciados de la unidad pilosebácea. Clínicamente se presenta como un nódulo cupuliforme, único, de color piel, con un pequeño orofocio central desde el cual puede protruir un mechón de pelos blancos algodonosos. Está confinado a la cabeza y cuello más comunmente que en la cara. Histológicamente se presenta como un folículo primario o una cavidad central, dilatada, de contenido queratínico variable y tapizada por un epitelio escamoso pluriestratificado, conectado a la epidermis vecina, desde la cual emergen brotes epiteliales secundarios que protruyen hacia la dermis, en forma radiada, conformando folículos secundarios, los cuales en ocasiones presentan pelo en su interior. Presentamos el caso de un paciente de sexo femenino portadora de este tumor y hacemos una breve revisión y planteamiento de sus diagnósticos diferenciales, tanto clínicos como histopatológicos

Foliculitis perforante y eritema nudoso atipico en curso de una hepatitis cronica persistente a virus no A - no B / Perforating folliculitis and atypical erythema nodosum persistent chronic hepatictis a virus non A non B

Se comunica un caso de H.C.P. a virus no A - no B asociada a un E.N.A. en su fase prodrómica - ictérica. Desde el inicio de la H.N.A.N.B. aparecen lesiones papulosas que clínica e histológicametne correspondían a una típica F.P.. No hemos hallado referencia bibliográficas de las manifestaciones cutáneas de la H.C.P. tipo N.A.N.B., siendo creemos el primer caso de F.P. asociada a esta patología sistémica en un paciente no hemodializado y no diabético