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Tufted Hair Folliculitis

  • Author: Elizabeth CW Hughes, MD; Chief Editor: William D James, MD  more...
 
Updated: May 03, 2016
 

Background

Tufted hair folliculitis is a rare, progressive pattern of scarring alopecia that affects the scalp. Its characteristic feature is the presence of groups of 10-15 hairs emerging from a single follicular opening. The cause of this disorder is unknown. Tufts of hair associated with scars have been described in association with several other forms of alopecia. It is probable that tufted hair folliculitis represents an advanced stage of follicular injury seen in several types of scarring alopecia.

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Pathophysiology

Tufted hair folliculitis affects hair follicles of the scalp. Biopsy specimens demonstrate convergence of follicular infundibula, with multiple hairs emerging from a single follicular opening, while the lower portions of the hair follicle are separate and unaffected by the scarring process. Staphylococcal organisms frequently are cultured from lesions of tufted hair folliculitis, but their role in pathogenesis is unclear.[1]

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Epidemiology

Frequency

Tufted hair folliculitis is rare.

Race

No racial predilection is recognized for tufted hair folliculitis.

Sex

No sex predilection is recognized for tufted hair folliculitis.

Age

Tufted hair folliculitis has been reported only in adults. It has been reported primarily in individuals in the fourth and fifth decades of life.

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Prognosis

Tufted hair folliculitis is a chronic condition. The patient may experience intermittent flares and periods of quiescence. Fortunately, morbidity is low and limited to local discomfort and cosmetic concerns. Mortality from tufted hair folliculitis has not been reported.

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Contributor Information and Disclosures
Author

Elizabeth CW Hughes, MD Dermatologist, Group Health Cooperative

Elizabeth CW Hughes, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Leonard Sperling, MD Chair, Professor, Department of Dermatology, Uniformed Services University of the Health Sciences

Leonard Sperling, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References
  1. Broshtilova V, Bardarov E, Kazandjieva J, Marina S. Tufted hair folliculitis: a case report and literature review. Acta Dermatovenerol Alp Panonica Adriat. 2011. 20(1):27-9. [Medline].

  2. Dalziel KL, Telfer NR, Wilson CL, Dawber RP. Tufted folliculitis. A specific bacterial disease?. Am J Dermatopathol. 1990 Feb. 12(1):37-41. [Medline].

  3. Smith NP, Sanderson KV. Tufted folliculitis of the scalp. J R Soc Med. 1978. 71:606-8.

  4. Tong AK, Baden HP. Tufted hair folliculitis. J Am Acad Dermatol. 1989 Nov. 21(5 Pt 2):1096-9. [Medline].

  5. Farhi D, Buffard V, Ortonne N, Revuz J. Tufted folliculitis of the scalp and treatment with cyclosporine. Arch Dermatol. 2006 Feb. 142(2):251-2. [Medline].

  6. Ena P, Fadda GM, Ena L, Farris A, Santeufemia DA. Tufted hair folliculitis in a woman treated with lapatinib for breast cancer. Clin Exp Dermatol. 2008 Nov. 33(6):790-1. [Medline].

  7. Annessi G. Tufted folliculitis of the scalp: a distinctive clinicohistological variant of folliculitis decalvans. Br J Dermatol. 1998 May. 138(5):799-805. [Medline].

  8. Powell JJ, Dawber RP, Gatter K. Folliculitis decalvans including tufted folliculitis: clinical, histological and therapeutic findings. Br J Dermatol. 1999 Feb. 140(2):328-33. [Medline].

  9. Güngör S, Yüksel T, Topal I. Tufted hair folliculitis associated with Melkersson-Rosenthal syndrome and hidradenitis suppurativa. Indian J Dermatol Venereol Leprol. 2014 Sep-Oct. 80(5):484. [Medline].

  10. Saijyo S, Tagami H. Tufted hair folliculitis developing in a recalcitrant lesion of pemphigus vulgaris. J Am Acad Dermatol. 1998 May. 38(5 Pt 2):857-9. [Medline].

  11. Ko DK, Chae IS, Chung KH, Park JS, Chung H. Persistent pemphigus vulgaris showing features of tufted hair folliculitis. Ann Dermatol. 2011 Nov. 23(4):523-5. [Medline]. [Full Text].

  12. Mirmirani P, Willey A, Headington JT, Stenn K, McCalmont TH, Price VH. Primary cicatricial alopecia: histopathologic findings do not distinguish clinical variants. J Am Acad Dermatol. 2005 Apr. 52(4):637-43. [Medline].

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Tufted hairs. Multiple hairs emerging a dilated follicular orifice with surrounding scarring alopecia.
 
 
 
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