Tufted Hair Folliculitis Workup

  • Author: Elizabeth CW Hughes, MD; Chief Editor: William D James, MD   more...
 
Updated: Jan 17, 2012
 

Laboratory Studies

  • A skin biopsy specimen can be obtained from the affected area. See Histologic Findings.
  • Bacterial culture of purulent exudate, biopsy specimen, or plucked hair, including antibiotic sensitivity, may be helpful in guiding treatment.
  • Fungal cultures are not positive. If a fungal organism is identified, consideration should be given to an alternate diagnosis.
  • Extensive laboratory tests generally are not revealing and are of little value.
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Histologic Findings

The epidermis shows hyperkeratosis, with parakeratosis, overlying a hyperplastic epidermis. Follicular plugging may be observed.

In the papillary and upper reticular dermis a perifollicular, mixed inflammatory cell infiltrate is present, including lymphocytes, plasma cells, and neutrophils. In areas of follicular rupture, giant cells that may contain fragments of hair shafts are present.

In areas of tufting, the outer root sheath in the infundibular section of the follicle is thinned. The normal spacing of the hairs is disrupted, resulting in convergence the upper portion of the follicles. Multiple hairs are seen emerging from a single follicular opening. Large numbers of telogen hairs may be identified in the tufts.

The deep reticular dermis and subcutis are normal, showing undisturbed anagen hair bulbs.

In cases of hair tufting associated with other causes of scarring hair loss, the histologic features reflect the primary cause of the alopecia.

Note, however, that one cannot rely solely on histology to make the diagnosis. Mirmirani et al demonstrated that cicatricial alopecias cannot be distinguished reliably from one another on the basis of histology findings.[11] Histologic findings must be interpreted in light of the clinical findings and bacterial culture results.

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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 and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

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

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of 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 and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

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. Feb 1990;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. Nov 1989;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. Feb 2006;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. Nov 2008;33(6):790-1. [Medline].

  7. Annessi G. Tufted folliculitis of the scalp: a distinctive clinicohistological variant of folliculitis decalvans. Br J Dermatol. May 1998;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. Feb 1999;140(2):328-33. [Medline].

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

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

  11. 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. Apr 2005;52(4):637-43. [Medline].

  12. Luelmo-Aguilar J, Gonzalez-Castro U, Castells-Rodellas A. Tufted hair folliculitis. A study of four cases. Br J Dermatol. Apr 1993;128(4):454-7. [Medline].

  13. Pujol RM, Garcia-Patos V, Ravella-Mateu A, Casanova JM, de Moragas JM. Tufted hair folliculitis: a specific disease?. Br J Dermatol. Feb 1994;130(2):259-60. [Medline].

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