Perforating Folliculitis Workup

  • Author: Suguru Imaeda, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 17, 2012
 

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.
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Imaging Studies

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

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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.

Specialty Editor Board

Timothy McCalmont, MD  Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco; Editor-in-Chief, Journal of Cutaneous Pathology

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

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

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.

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: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

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 Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the significant contributions of previous author, James W. Patterson, MD, to the development and writing of this article which has been recently updated.

References

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Typical appearance of lesions of perforating folliculitis consisting of keratotic follicular papules.
 
 
 
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