Tufted Hair Folliculitis Workup

Updated: Aug 07, 2019
  • Author: Elizabeth CW Hughes, MD; Chief Editor: William D James, MD  more...
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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.


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. [13] Histologic findings must be interpreted in light of the clinical findings and bacterial culture results.