eMedicine Specialties > Dermatology > Diseases of the Adnexa

Perforating Folliculitis: Differential Diagnoses & Workup

Author: Suguru Imaeda, MD, Chief of Dermatology, Yale University Health Services; Chief of Dermatology, West Haven Veterans Affairs Medical Center; Assistant Professor, Department of Dermatology, Yale University School of Medicine
Contributor Information and Disclosures

Updated: Jun 18, 2009

Differential Diagnoses

Acneiform Eruptions
Keratosis Pilaris
Dermatologic Manifestations of Renal Disease
Kyrle Disease
Elastosis Perforans Serpiginosum
Pityrosporum Folliculitis
Folliculitis
Reactive Perforating Collagenosis
Gram-Negative Folliculitis

Workup

Laboratory Studies

  • In perforating folliculitis, perform renal function studies, including urinalysis, serum creatinine, and creatinine clearance, to evaluate for possible underlying renal disease, if warranted by history and/or physical findings.
  • Test blood glucose levels to evaluate for possible diabetes mellitus.

Imaging Studies

  • Imaging is not applicable to the evaluation of a patient with perforating folliculitis.

Procedures

  • Skin biopsy for perforating folliculitis
    • Biopsy is indicated when uncertainty about the nature of an eruption exists, ie, whether or not it is a folliculitis. In particular, consultants in other specialties, such as nephrologists who are following patients for chronic renal failure, may wish to exclude vasculitis, an infectious process, or a drug eruption. Biopsy also helps distinguish perforating folliculitis from other inflammatory disorders of the hair follicle, such as irritant folliculitis, acneiform folliculitis, or infectious folliculitis (eg staphylococcal, Pseudomonas- induced, or Pityrosporum- induced folliculitis).
    • Since histopathologic findings in perforating folliculitis are focal, they can be missed if a skin biopsy is sectioned incompletely. As a result, a pathology report may be returned with a nonspecific diagnosis. To avoid this, a small punch biopsy that completely encompasses the lesion is recommended. The clinician should indicate on the accession form that perforating folliculitis is suspected and that multiple sections may be necessary to demonstrate diagnostic changes.

Histologic Findings

The involved hair follicle in perforating folliculitis shows focal disruption of its lateral wall, with a transepithelial channel and, often, a parakeratotic luminal plug. Connective-tissue elements, including collagen and elastin, and varying numbers of inflammatory cells can be found within this transfollicular channel and within the follicular lumen, admixed with parakeratotic keratin. In some cases, a hair shaft or hair fragment can be demonstrated within the follicular lumen and/or within the transfollicular channel. The dermis surrounding the follicle typically shows sparse inflammation and focal fibrosis.

More on Perforating Folliculitis

Overview: Perforating Folliculitis
Differential Diagnoses & Workup: Perforating Folliculitis
Treatment & Medication: Perforating Folliculitis
Follow-up: Perforating Folliculitis
Multimedia: Perforating Folliculitis
References
[ CLOSE WINDOW ]

References

  1. Abe R, Murase S, Nomura Y, et al. Acquired perforating dermatosis appearing as elastosis perforans serpiginosa and perforating folliculitis. Clin Exp Dermatol. Aug 2008;33(5):653-4. [Medline].

  2. Carter VH, Constantine VS. Kyrle's disease. I. Clinical findings in five cases and review of literature. Arch Dermatol. Jun 1968;97(6):624-32. [Medline].

  3. Tappeiner J, Wolff K, Schreiner E. [Kyrle's disease]. Hautarzt. Jan 1969;20(1):296-310. [Medline].

  4. Mehregan AH, Coskey RJ. Perforating folliculitis. Arch Dermatol. Apr 1968;97(4):394-9. [Medline].

  5. Pavlovic MD, Zecevic RD, Stamenkovic M, Stojadinovic O, Zolotarevski L. Trauma-induced perforating folliculitis. Eur J Dermatol. Nov-Dec 2003;13(6):592. [Medline].

  6. Burkhart CG. Perforating folliculitis. A reappraisal of its pathogenesis. Int J Dermatol. Nov 1981;20(9):597-9. [Medline].

  7. Hurwitz RM. The evolution of perforating folliculitis in patients with chronic renal failure. Am J Dermatopathol. Jun 1985;7(3):231-9. [Medline].

  8. White CR Jr, Heskel NS, Pokorny DJ. Perforating folliculitis of hemodialysis. Am J Dermatopathol. Apr 1982;4(2):109-16. [Medline].

  9. Bilezikci B, Seckin D, Demirhan B. Acquired perforating dermatosis in patients with chronic renal failure: a possible pathogenetic role for fibronectin. J Eur Acad Dermatol Venereol. Mar 2003;17(2):230-2. [Medline].

  10. Headley CM, Wall B. ESRD-associated cutaneous manifestations in a hemodialysis population. Nephrol Nurs J. Dec 2002;29(6):525-7, 531-9; quiz 540-1. [Medline].

  11. Hong SB, Park JH, Ihm CG, Kim NI. Acquired perforating dermatosis in patients with chronic renal failure and diabetes mellitus. J Korean Med Sci. Apr 2004;19(2):283-8. [Medline].

  12. Hurwitz RM, Melton ME, Creech FT 3rd, Weiss J, Handt A. Perforating folliculitis in association with hemodialysis. Am J Dermatopathol. Apr 1982;4(2):101-8. [Medline].

  13. Kahana M, Trau H, Dolev E, Schewach-Millet M, Gilon E. Perforating folliculitis in association with primary sclerosing cholangitis. Am J Dermatopathol. Jun 1985;7(3):271-6. [Medline].

  14. Mahajan S, Koranne RV, Sardana K, Mendiratta V, Damani A. Perforating folliculitis with jaundice in an Indian male: a rare case with sclerosing cholangitis. Br J Dermatol. Mar 2004;150(3):614-6. [Medline].

  15. Patterson JW, Graff GE, Eubanks SW. Perforating folliculitis and psoriasis. J Am Acad Dermatol. Sep 1982;7(3):369-76. [Medline].

  16. Neill SM, Pembroke AC, du Vivier AW, Salisbury JR. Phrynoderma and perforating folliculitis due to vitamin A deficiency in a diabetic. J R Soc Med. Mar 1988;81(3):171-2. [Medline].

  17. Fistarol SK, Itin PH. Acquired perforating dermatosis in a patient with Poland syndrome. Dermatology. 2003;207(4):390-4. [Medline].

  18. Rubio FA, Herranz P, Robayna G, Pena JM, Contreras F, Casado M. Perforating folliculitis: report of a case in an HIV-infected man. J Am Acad Dermatol. Feb 1999;40(2 Pt 2):300-2. [Medline].

  19. Gilaberte Y, Coscojuela C, Vazquez C, Rosello R, Vera J. Perforating folliculitis associated with tumour necrosis factor-alpha inhibitors administered for rheumatoid arthritis. Br J Dermatol. Feb 2007;156(2):368-71. [Medline].

  20. Wolber C, Udvardi A, Tatzreiter G, Schneeberger A, Volc-Platzer B. Perforating folliculitis, angioedema, hand-foot syndrome--multiple cutaneous side effects in a patient treated with sorafenib. J Dtsch Dermatol Ges. May 2009;7(5):449-52. [Medline].

  21. Ohe S, Danno K, Sasaki H, Isei T, Okamoto H, Horio T. Treatment of acquired perforating dermatosis with narrowband ultraviolet B. J Am Acad Dermatol. Jun 2004;50(6):892-4. [Medline].

  22. Zachariae H, Sogaard H. Progressive generalized perforating folliculitis. Dermatologica. 1984;168(3):131-7. [Medline].

  23. Ashton RE, Montheith PG. Successful treatment of perforating folliculitis with 13-cis-retinoic acid. J Dermatol Treat. 1992;3:67-8.

  24. Chang P, Fernández V. Acquired perforating disease: report of nine cases. Int J Dermatol. Dec 1993;32(12):874-6. [Medline].

  25. Combemale P, Courtois D, Chouvet B. [Perforating folliculitis]. Ann Dermatol Venereol. 1990;117(8):515-20. [Medline].

  26. Patterson JW. The perforating disorders. J Am Acad Dermatol. Apr 1984;10(4):561-81. [Medline].

  27. Patterson JW, Brown PC. Ultrastructural changes in acquired perforating dermatosis. Int J Dermatol. Mar 1992;31(3):201-5. [Medline].

  28. Sehgal VN, Jain S, Thappa DM, Bhattacharya SN, Logani K. Perforating dermatoses: a review and report of four cases. J Dermatol. Jun 1993;20(6):329-40. [Medline].

  29. Tsunoda T, Horiuchi N, Deguchi M, Manoma H. Three cases of perforating folliculitis. Japanese Journal of Clinical Dermatology. Nov 1999;53:908-10.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

perforating folliculitis, acquired perforating dermatosis, Kyrle disease, Kyrle's disease, hyperkeratosis follicularis et parafollicularis in cutem penetrans, perforating disorder of renal failure, elastosis perforans serpiginosum, perforating elastosis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Suguru Imaeda, MD, Chief of Dermatology, Yale University Health Services; Chief of Dermatology, West Haven Veterans Affairs Medical Center; Assistant Professor, Department of Dermatology, Yale University School of Medicine
Suguru Imaeda, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Connecticut State Medical Society, Sigma Xi, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Timothy McCalmont, MD, Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco
Timothy McCalmont, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Dermatopathology, California Medical Association, College of American Pathologists, and United States and Canadian Academy of Pathology
Disclosure: Apsara Consulting fee Independent contractor

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Rosalie Elenitsas, MD, Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System
Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.