eMedicine Specialties > Dermatology > Diseases of the Adnexa

Perforating Folliculitis: Treatment & Medication

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

Treatment

Medical Care

Since some cases of perforating folliculitis are associated with systemic disorders (eg, diabetes mellitus, chronic renal failure), direct therapeutic efforts towards the underlying condition in these patients. In a case report of perforating folliculitis in a patient with diabetes mellitus and phrynoderma, the skin lesions resolved with correction of the vitamin A deficiency. Soothing antipruritic lotions may be helpful for patients in whom itching is a significant problem. UV-B irradiation also may be of general benefit in the control or amelioration of pruritus.21

Assessing treatments for perforating folliculitis is difficult. Although the condition is not uncommon, controlled therapeutic studies are not available. Unsuccessful treatments have included oral beta-carotene, keratolytics, antiacne therapies, and topical corticosteroids. A case of perforating folliculitis reported by Zachariae and Sogaard featured progressive generalized perforating folliculitis combined with erythroderma, keratoderma, and alopecia and was resistant to corticosteroids, corticotropin, psoralen plus UV-A, cytostatic agents, and aromatic retinoids.22 A case of phrynoderma with perforating folliculitis reported by Neill et al responded to 50,000 U/d of beta-carotene for 1 month, followed by 2000 U/d.16 Hurwitz found that a combination of antistaphylococcal therapy, phototherapy, and a topical corticosteroid lotion was helpful in controlling perforating folliculitis in patients with chronic renal failure.7

Tretinoin 0.1% cream has cleared some perforating folliculitis lesions but has not prevented the development of others. A case of successful treatment using 13-cis -retinoic acid has been reported.23

A 2004 study of 5 perforating folliculitis patients showed good clinical responses with narrowband UV-B therapy. Patients were treated 2-3 times weekly. The initial dose was 400 mJ/cm2, with increases to a maximum of 1500 mJ/cm2. Lesions completely resolved after 10-15 exposures, although some recurrences were observed.21

Surgical Care

Surgical intervention is not required for perforating folliculitis lesions.

Consultations

  • Dermatologist: Practitioners may wish to consult a dermatologist when uncertainty regarding a papular eruption exists in a patient. Dermatologists often are able to determine clinically whether such an eruption is likely to be a folliculitis, and they can appreciate subtle lesional changes that suggest a perforating folliculitis. Dermatologists also can suggest or perform the proper type of biopsy procedure for this type of folliculitis.
  • Internist: Specialists in internal medicine should be consulted for management of patients in whom perforating folliculitis may be associated with an underlying medical condition, such as chronic renal failure, diabetes mellitus, or atherosclerotic cardiovascular disease.
  • General surgeon: Consultation with a surgeon may be indicated for patients whose perforating folliculitis is associated with chronic renal failure. Renal transplantation may be an option.8

More on Perforating Folliculitis

Overview: Perforating Folliculitis
Differential Diagnoses & Workup: Perforating Folliculitis
Treatment & Medication: Perforating Folliculitis
Follow-up: Perforating Folliculitis
Multimedia: Perforating Folliculitis
References
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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.

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Further Reading

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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

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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.

 
 
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