eMedicine Specialties > Dermatology > Diseases of the Adnexa

Disseminate and Recurrent Infundibular Folliculitis

Author: Stephen W White, MD, Clinical Assistant Professor, Department of Dermatology, George Washington University Hospital; Chief, Sub-section of Dermatology, Suburban Hospital
Coauthor(s): Christopher R Gorman, MD, Bethesda Dermatology, private practice
Contributor Information and Disclosures

Updated: Oct 30, 2009

Introduction

Background

Disseminate and recurrent infundibular folliculitis (DRIF) was first described in 1968 by Hitch and Lund.¹ The clinical presentation is much like miliaria or keratosis pilaris. It is mostly seen in young healthy people, and most patients have a dark skin color. It consists of generalized flesh-colored papules. Therapy has generally been unsuccessful.

Pathophysiology

The etiology of disseminate and recurrent infundibular folliculitis is not established.

Frequency

United States

Although the first case of disseminate and recurrent infundibular folliculitis was not reported until 1968, other more recent reports indicate that it is a fairly common occurrence. Clinics that see a large number of young dark-skinned patients report that disseminate and recurrent infundibular folliculitis is a common condition. Indeed, it may occur in large numbers in hot, humid weather.

International

Cases of disseminate and recurrent infundibular folliculitis have been reported from Europe and India.

Mortality/Morbidity

Pruritus is the troublesome symptom of disseminate and recurrent infundibular folliculitis. In the past, this was difficult to relieve. The condition may be recurrent over a number of years. Disseminate and recurrent infundibular folliculitis may make it uncomfortable for the patient to work in a hot, humid environment.

Race

Disseminate and recurrent infundibular folliculitis has been reported primarily in people of African American origin in the United States.² Why a number of dermatoses tend to be papular and follicular in dark-skinned people is not known. This phenomenon is well documented in atopic dermatitis.

Sex

Although most of the patients are men, disseminate and recurrent infundibular folliculitis has been reported in women.

Age

Most of the reported disseminate and recurrent infundibular folliculitis patients have been healthy young adults.

Clinical

History

• Most patients report a sudden onset of a widespread pruritic papular eruption.
• Disseminate and recurrent infundibular folliculitis has been reported to be exacerbated by hot showers and relieved by anything that cools (eg, cool showers, lotions, swimming).
• Occasionally, a patient may report that a number of peers have been affected at the same time.
• Often, disseminate and recurrent infundibular folliculitis patients have a personal or family history of atopy.

Physical

• Physical examination in disseminate and recurrent infundibular folliculitis reveals a papular eruption that has a follicular location.
• In a given area, all the follicles are involved, with no skipping of any follicles in the area involved.
• The usual sites are the chest and mantle and the upper arms.
• Infundibular folliculitis is rather monomorphic without noted rubor, calor, and dolor.

Causes

• The exact cause of disseminate and recurrent infundibular folliculitis is unknown.
• The history often suggests a hot, humid environment as a precipitating cause.
• Once established, disseminate and recurrent infundibular folliculitis tends to persist or recur over a prolonged period.

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