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Folliculitis-It's More Than Acne!

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Folliculitis-It's More Than Acne! Paul K. Shitabata, M.D. Dermatopathology Institute Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 SAPHO Syndrome Synovitis Acne Pustulosis Hyperostosis Osteitis Thursday, May 23, 13 Acne Conglobata Severe form of acne characterized by burrowing and interconnecting abscesses and irregular scars Chest, shoulders, back, buttocks, upper arms, thighs, and face Sudden deterioration of existing active papular or pustular acne Recrudescence of quiescent acne Thursday, May 23, 13 Chloracne Toxic chemicals exposure (dioxins) Few months after swallowing, inhaling or touching Occupational exposure, enviromental poisoning Ukrainian President Victor Yushchenko Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Histopathology Folliculitis with varying degrees of the following depending upon the stage and temporal progression Telangiectasia Sebaceous hyperplasia Fibrosis Granulomas Thursday, May 23, 13 Disease Associaons of Acne Rosacea Steroid rosacea HIV-1 Pyoderma faciale Perioral dermatitis Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Histopathology Hair shaft infiltrated by fungal yeast and hyphae May have epidermal involvement Suspect with acute suppurative folliculitis Woods lamp negative PAS/GMS to confirm T. tonsurans most common Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Histopathology Folliculitis with variable degree of eosinophils Clinical correlation CD4 count correlation Rule out other infection Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Histopathology Viral cytopathic changes in the hair follicle May not have epidermal involvement Thursday, May 23, 13 Exclusive involvement of folliculosebaceous units by herpes: a reflec*on of early herpes zoster. Three patients with non-vesicular eruptions on the head and neck Bx: Exclusive folliculosebaceous involvement by herpes All developed typical herpes zoster within days of the biopsy Virus is transported from dorsal root or trigeminal ganglia via myelinated nerves to the skin which terminate at the isthmus of hair follicles and primary infection of follicular and sebaceous epithelium occurs Spread of infection to the epidermis follows In contrast, data pertaining to recurrent herpes simplex indicates that axonal transport of the virus from sensory ganglia to the skin is directed primarily to the epidermis, via terminal non-myelinated nerve twigs Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Histopathology Folliculitis with transepidermal elimination of collagen May have dermal collection of neutrophils adjacent to follicle Consider elastic stains Deeper levels may be necessary Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Histopathology Follicle expanded or obliterated by mucin Associated lymphocytic infiltrate May lead to scarring alopecia Rule out MF Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Histopathology May lack epidermal involvement May be associated with follicular mucinosis Confirm by IHC or gene rearrangement Thursday, May 23, 13 Quesons Retirement at sixty- five is ridiculous. When I was sixty-five I still had pimples. George Burns (1896 - 1996) Thursday, May 23, 13.
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