Tufted hair folliculitis

Abstract

A 58-year-old Caucasian man had a 3-year history of a painful plaque on the vertex area. Physical examination disclosed an erythematous plaque 5 x 5 cm in diameter with multiple tufts of 5-8 normal looking hairs arising from a single dilated follicular opening as well as follicular pustules. Some tufts had collarettes of scales at the follicular orifice. KOH staining and fungal cultures were negative. Bacterial culture of the exudate fluid emerging from the follicular opening gave rise to Staphylococcus aureus growth. Histological examination showed fibrosis of the dermis and mixed inflammatory infiltrate composed predominantly of neutrophils and plasma cells, localized around the upper portions of the follicles. Several follicles were seen converging in a common large follicular duct containing telogen hairs. The patient was treated with minocycline 100 mg/day for 20 days, with marked improvement of the lesion. The treatment produced resolution of suppuration and scaling and some regrowth of normal appearing hair at the periphery of the lesion. The condition, however recurred fully after 15 days but improved again following an additional course of minocycline.