A new approach to actinic folliculitis: prophylactic narrowband ultraviolet B phototherapy.

BACKGROUND: We have observed an increasing number of patients referred to the Scottish Photobiology Service (SPS), who were later diagnosed with actinic folliculitis (AF) and had positive phototesting results. Treatment options for AF are limited, with only a few reports in the literature. The use of prophylactic narrowband ultraviolet B (NB-UVB) phototherapy for AF has not previously been described, and we report on this for the first time. AIM: To analyse the clinical characteristics, phototesting results and responses to treatment for patients with AF diagnosed by the SPS. METHODS: We undertook a retrospective review over 10 years of all case notes of patients who were assessed and diagnosed with AF through the SPS, based at the Photobiology Unit, Dundee, UK. RESULTS: All 10 patients were women. Mean age of onset was 25 years and mean time to referral for investigation was 7 years. The commonest site involved was the face, with the main clinical feature being monomorphic pustules appearing after sunlight exposure. The eruption could be provoked with iterative doses of broadband UVA irradiation in five patients. All patients were offered photoprotective advice and prophylactic NB-UVB phototherapy. Five patients proceeded with phototherapy; four of these completed the desensitization course and all four reported either a delay in symptom onset or total prevention of rash induction, with complete efficacy of desensitization maintained for 3 years in one patient. CONCLUSION: We demonstrate the successful use of UVA provocation testing as a diagnostic tool in AF. Additionally, we recommend the use of prophylactic NB-UVB phototherapy in AF as an effective and well-tolerated approach.

Micosis fungoide foliculotropa. Análisis y evolución de 6 casos / Folliculotropic mycosis fungoides. Analysis and outcomes of six cases

La micosis fungoide foliculotropa (MFF) es considerada una variante rara de micosis fungoide con mala respuesta a la terapéutica, pronóstico severo y sobrevida más corta . Incluye casos con y sin mucinosis folicular (Mf) MATERIAL Y MÉTODO: Analisis de 6 casos de MFF que consultaron en la División Dermatología desde junio de 1994 a junio del 2010 incluyó el estudio clínico, histopatológico, e inmunohistoquímico, respuesta terapeútica y evolución de los mismos. Las biopsias de tres de los seis casos estudiados exhibieron Mf y en otros tres este aspecto estuvo ausente. OBJETIVO: Comunicar nuestros hallazgos, considerando para estimar la sobrevida, el período previo al diagnóstico de MF, a través de un nuevo examen de las biopsias previas. RESULTADOS Y CONCLUSIONES: En nuestra población: a) Esta forma de MF ofreció dificultades diagnósticas presentando aspectos clínicos inusuales y hallazgos microscópicos inespecíficos. b) El estadio previo de Mf o los hallazgos microscópicos inespecíficos pudo ser muy prolongado, hasta surgir los criterios diagnósticos de MF (2 a 11 años). c) Los tapones córneos foliculares tuvieron respuesta total al bexarotene. Placas y máculas respondieron temporalmente a la fototerapia. La eritrodermia persistió después de dos años de tratamiento con IFNα 2b y bexarotene oral. d) Aunque la muestra es pequeña, estos datos parecen aseverar el peor pronóstico a 10 años de esta variante si no se consideran los años previos a la confirmación del diagnóstico de MF. La sobrevida a 5 años fue 75% (3/4), y a 10 años 25% (1/4) . Teniendo en cuenta la etapa previa de MF no diagnosticada por otros observadores, la severidad se atenúa 100% de sobrevida a 5 años, y 60% a 10 años. Ninguno experimentó regresión espontánea de las lesiones durante el tiempo de observación

Folliculotropic mycosis fungoides is considered a rare variant of mycosis fungoides with a bad response to therapy, severe prognosis and shorter over-life. It includes cases with and without follicular mucinosis MATERIAL AND METHOD: We report the retrospective analysis of clinical, histopathological, and immunohistochemical aspects, therapeutic responses and follow-up of six cases of folliculotropic mycosis fungoides studied in the Department of Dermatology from May 1994 to June 2010. Three of them exhibited follicular mucinosis in cutaneous biopsies and other three failed to reveil this finding. OBJECTIVE: To report our findings taking into account the years previous to diagnosis of MF (by re-examination of previous biopsies) in order to stimate the ove rlife. RESULTS AND CONCLUSIONS: In this population: a) This variant of MF was very difficult to be diagnosed presenting unusual clinical lesions and unspecific microscopic patterns. b) Previous stage of primary follicular mucinosis or unspecific microscopic findings could be quite long (2 to 11 years) until MF criteria were fulfilled. c) Comedo-like lesions had a good response to bexarotene. Therapeutic responses of plaques and macules to phototherapy and systemic α2bIFNwere partial and brief. d) Although the significance was limited by the small number of the sample ,these data seems to assess the worser prognosis to ten years of this variant if the years previous to confirmation of MF diagnosis were not considered: The over life at 5 years was 75%(3/4), at 10 years 25% (1/4). Taking into account the period of undiagnosed MF the severity was atempered: overlife100% at 5 years (6/6), 60% at 10 years (4/6). Nobody experimentedthe spontaneous remission of the lesions during the time of observation

Pruritic erythematous maculopapular rash.

A trip to the beach left this patient with an unusual rash where his bathing suit had been.

Micosis fungoide folicular. Estudio de cuatro casos / Folliculotropic mycosis fungoides. Study of four cases

La micosis fungoide folicular (MFF) es una variante de micosis fungoide (MF) caracterizada por la presencia de infiltrados foliculares, a menudo respetando la epidermis, y con afectación preferente de cabeza y cuello. Presentamos nuestra experiencia con 4 casos de MFF vistos en nuestro Servicio en los últimos años. Se trata de 4 pacientes (tres varones y una mujer) con edades comprendidas entre los 45 y 68 años. Clínicamente las lesiones se presentaron en forma de quistes, comedones, pápulas foliculares y placas con acentuación folicular. El estudio histopatológico mostró un infiltrado de distribución peri e intrafolicular con la epidermis parcial o totalmente respetada. Este infiltrado estaba formado principalmente por linfocitos atípicos. Se apreciaban también algunas formaciones quísticas. En tres casos se observaron depósitos de mucina y en uno siringotropismo. El análisis inmunohistoquímico fue positivo para los marcadores CD3, CD5 y CD4. Todos los pacientes recibieron diferentes tratamientos en función del estadio de su enfermedad. Uno de ellos falleció de shock séptico y el resto presentó respuestas parciales y recidivas frecuentes

Folliculotropic mycosis fungoides is a variant of mycosis fungoides characterized by the presence of folliculotropic infiltrates, often with sparing of the epidermis, and preferential involvement of the head and neck. We report our experience with four cases of folliculotropic mycosis fungoides followed in our department in the last years. There are four patients (three men and one woman) aged 45 to 68 years. Clinically the lesions presented as cysts, comedones, follicular papules and plaques with follicular plugging. The histopathological study showed a peri and intrafollicular infiltrate with partial or total sparing of the epidermis. This infiltrate was mainly composed of atypical lymphocytes. Some cystic formations were also observed. Three cases showed mucin deposits and one showed syringotropism. The immunohistochemical analysis was positive for CD3, CD5 and CD4. All patients received different treatments based on the stage of their disease. One of them died of septic shock and the rest showed partial responses and frequent relapses

Eosinophilic pustular folliculitis: a comprehensive review of treatment options.

Eosinophilic pustular folliculitis (EPF), also known as Ofuji disease, is a disease that manifests with follicular papules or pustules. Its variants include a classic type that occurs most commonly in Japan, an HIV-associated type, an infantile type, a type that occurs on the palms and soles, a rare medication-associated variant, and a rare neoplasia-associated variant.A wide range of medications has been used to treat EPF. Topical corticosteroids are the first-line treatment option for EPF. Topical tacrolimus seems to be useful initial therapy as well. Oral indometacin (50-75 mg/day) is an effective treatment of classic EPF although it can induce peptic ulcers. For treatment of HIV-associated EPF when topical corticosteroids and indometacin do not work, various other treatments should be considered. These treatment options include cetirizine 20-40 mg/day, metronidazole 250 mg three times a day, itraconazole starting at a dosage of 200 mg/day and increasing to 300-400 mg/day, and topical permethrin. If these treatments do not work phototherapy with UVB is the 'gold standard' of treatment and is often curative. Treatments with less certain risk-benefit ratios but with some efficacy include PUVA (psoralen + UVA) photochemotherapy, oral corticosteroids, synthetic retinoids (i.e. isotretinoin 1 mg/kg/day), and acitretin (0.5 mg/kg/day), oral cyclosporine (ciclosporine) 5 mg/kg/day, interferon (IFN)-alpha-2b, and IFNgamma. Minocycline 100mg twice daily and dapsone 50-100mg twice daily have been used with some effect. The use of highly active antiretroviral therapy for HIV has resulted in the amelioration of EPF as CD4 cell counts rise above 250/mm(3). The diversity of clinical presentations and affected populations make it seem that EPF is a reaction pattern as much as a disease and that therapy should be tailored to the variant of EPF and the underlying etiology.

Foliculitis de pelos en penacho / Tufted hair folliculitis

La foliculitis en penacho (tufted hair folliculitis), fue descrita por Smith & Sanderson en 1978 como un proceso inflamatorio exudativo, crónico y poco frecuente, localizado en los folículos del cuero cabelludo. Los pelos así afectados se agrupan en grupos a modo de penacho reuniéndose de 10 a 15 elementos pilosos. Irregularmente distribuidos, estos elementos forman placas inflamatorias levemente supurantes que terminan con una alopecia cicatricial irreversible. El aspecto clínico es muy peculiar y distinto a otras formas patogénicas generadoras de alopecia. En esta entidad al comienzo se desarrollan placas eritematosas y edematosas con pústulas y exudación, a la que también se añaden costras y fina descamación. Su evolución tiende a la fibrosis y al desarrollo de una placa alopécica cicatricial. Se comunica el caso de un varón de 34 años de edad que consultó por la presencia de una placa de estas características en el vertex del cuero cabelludo. Se comenta su diagnosis, evolución, y respuesta al tratamiento con isotretinoina y cloxacilina oral (AU)

Localized whirlpool folliculitis in a football player.

Pseudomonas aeruginosa folliculitis occurs in patients exposed to contaminated water. Most out-breaks are associated with whirlpools. The infection is characterized by follicular, erythematous papules and pustules located on immersed body surfaces. Most reported cases are the result of recreational water use, occur in a diffuse pattern, and are devoid of green pustular pigment changes. The case described occurred in a football player after whirlpool treatment for an ankle strain. Green pustules and a localized affected area are unusual aspects of this case.

Oncotaxia inflamatoria en lesiones de foliculitis de un paciente con leucemia mieloide aguda / Inflammatory oncotaxis in folliculitis lesions of a patient with acute myelogenous leukemia

Un varón de 68 años diagnosticado de leucemia aguda mieloide presentó lesiones cutáneas de foliculitis. Histológicamente se encontró una foliculitis neutrofílica junto con células blásticas perifoliculares. Las lesiones cutáneas desaparecieron tras un tratamiento antibiótico, mientras que la leucemia empeoraba pese al tratamiento quimioterápico (AU)