History

In perforating folliculitis, papules typically are concentrated on hair-bearing portions of the extremities (arms, thighs) and buttocks. Often, lesions are asymptomatic, although pruritus may be a striking feature, especially in patients with renal insufficiency. Lesions may wax and wane and persist for months or years. Spontaneous remission can occur, and remission following renal transplantation has been documented in 1 patient who developed lesions secondary to renal failure.

Physical Examination

Typical primary lesions of perforating folliculitis consist of 2-8 mm diameter scaly folliculocentric papules with small central keratotic plugs and varying degrees of erythema (see the image below).

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

Compression of papules may yield keratin debris and a coiled hair or hair fragments. An initial eruption of follicular pustules, followed by typical plugged papules and subsequent development of prurigo-nodularis–like lesions was reported in 1 study. The Köebner phenomenon usually is not readily demonstrable, but a linear configuration occasionally can be observed. A case of progressive generalized perforating folliculitis has been reported to be associated with erythroderma, keratoderma of the palms and soles, alopecia of the scalp and eyebrows, and nail changes. Accompanying jaundice has been observed in patients with underlying liver disease.^[29]

Complications

Potential complications of perforating folliculitis include secondary infection of lesions (resulting from trauma or other factors), spread of lesions despite therapy, or adverse effects of treatments, such as irritation from topical retinoids or atrophy and telangiectasia from chronic topical corticosteroid use.

Perforating folliculitis complications related to any underlying medical conditions may occur.

Differential Diagnoses

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White CR Jr, Heskel NS, Pokorny DJ. Perforating folliculitis of hemodialysis. Am J Dermatopathol. 1982 Apr. 4(2):109-16. [QxMD MEDLINE Link].
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Media Gallery

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

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Author

Suguru Imaeda, MD Chief of Dermatology, Yale University Health Services; Chief of Dermatology, Veterans Affairs Connecticut Healthcare System; 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, The Scientific Research Honor Society, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Rosalie Elenitsas, MD Herman Beerman 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, American Medical Association, American Society of Dermatopathology, Pennsylvania Academy of Dermatology

Disclosure: Received royalty from Lippincott Williams Wilkins for textbook editor.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Andrea Leigh Zaenglein, MD Professor of Dermatology and Pediatrics, Department of Dermatology, Hershey Medical Center, Pennsylvania State University College of Medicine

Andrea Leigh Zaenglein, MD is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology

Disclosure: Received consulting fee from Galderma for consulting; Received consulting fee from Valeant for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Anacor for consulting; Received grant/research funds from Stiefel for investigator; Received grant/research funds from Astellas for investigator; Received grant/research funds from Ranbaxy for other; Received consulting fee from Ranbaxy for consulting.

Acknowledgements

The authors and editors of Medscape Reference 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.

Perforating Folliculitis Clinical Presentation

History

Physical Examination

Complications

References

Tables

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