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J Am Acad Dermatol 2020 Apr 6. Epub 2020 Apr 6.

Department of Dermatology, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.

Background: Folliculitis decalvans (FD) is a form of inflamed primary cicatricial alopecia (PCA). FD is classified as a neutrophilic PCA; however, only a few previous studies have described its histopathology, including the assessment of systematically evaluated and quantified follicular changes in horizontally sectioned biopsy specimens with clinical and dermoscopic findings of the early and advanced stages.

Objective: We aimed to clarify the histopathological and dermoscopic features of early and advanced active stage FD. Read More

J Dermatol Sci 2020 Jan 16;97(1):83-85. Epub 2019 Dec 16.

Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan.

Dermatol Ther (Heidelb) 2019 Sep 12;9(3):525-535. Epub 2019 Jun 12.

Department of Dermatology and Venereology, Başkent University Faculty of Medicine, Ankara, Turkey.

Introduction: Clinical diagnosis of primary cicatricial alopecias presents difficulties. Studies regarding their trichoscopic features are scarce and mostly not comprehensive. The aim of this study is to evaluate the potential benefit of a handheld dermatoscope in clinical diagnosis of primary cicatricial alopecias. Read More

Int J Immunopathol Pharmacol 2018 Mar-Dec;32:2058738418814688

Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute IRCCS, Rome, Italy.

Folliculitis decalvans is a rare clinical disorder classified as primary neutrophilic scarring alopecia with a slight preference for the male gender. Here, we report the use of autologous fat transplantation as a source of stem cell therapy for hair re-growth assisted by inflammatory action of the fat itself in a female patient. The patient underwent adipose transplantation in April and September 2017. Read More

Case Rep Dermatol 2016 Jan-Apr;8(1):85-90. Epub 2016 Apr 20.

Dermatology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.

An uncommon type of epidermal nevus characterized by hyperpigmented hyperkeratotic bands following a Blaschko-linear pattern and generalized follicular hyperkeratosis were observed in a 17-year-old male patient who additionally showed tufted hair folliculitis on the scalp and clinodactyly of the fifth finger of both hands. The combination of epidermal nevus with skeletal abnormalities was first described by Gobello et al. [Dermatology 2000;201:51-55] as a new epidermal nevus syndrome that was named after the first author of this work. Read More

Curr Probl Dermatol 2015 20;47:76-86. Epub 2015 Feb 20.

Scarring alopecia or cicatricial alopecia results from follicular damage that is sufficient to cause the destruction and replacement of pilosebaceous structures by scar tissue. Primary scarring alopecias represent a group of disorders that primarily affect the hair follicles, as opposed to secondary scarring alopecias, which affect the dermis and secondarily cause follicular destruction. Inflammation may predominantly involve lymphocytes or neutrophils. Read More

Indian J Dermatol Venereol Leprol 2014 Sep-Oct;80(5):484

Department of Dermatology, Okmeydanı Training and Research Hospital, Istanbul, Turkey.

J Drugs Dermatol 2012 Jun;11(6):753-8

Department of Dermatology, Clinical Hospital of Ministry of Internal Affairs, Warsaw, Poland.

Background: Trichoscopy is widely used in differential diagnosis of non-cicatricial alopecia.

Objective: The aim of this prospective study was to identify possible characteristic trichoscopy patterns of diseases leading to primary cicatricial alopecia.

Methods: Trichoscopy was performed in a total of 1,884 consecutive patients presenting with hair loss. Read More

J Dermatol Case Rep 2011 Dec;5(4):82-8

Department of Dermatology, CSK MSWiA, Warsaw, Poland.

Trichoscopy performed with a handheld dermoscope or a videodermoscope became an indispensable tool in differential diagnosis of hair and scalp diseases. Current research is focusing on trichoscopy of: 1) non-cicatricial alopecia, 2) cicatricial alopecia, 3) hair shaft disorders, and 4) inflammatory scalp diseases. This review summarizes current knowledge in these four fields of research. Read More

Ann Dermatol 2011 Nov 3;23(4):523-5. Epub 2011 Nov 3.

Department of Dermatology, College of Medicine, The Catholic University of Daegu, Daegu, Korea.

Pemphigus vulgaris is an autoimmune blistering disease that commonly involves the scalp. Lesions of pemphigus vulgaris that persist on the scalp for a long period may be accompanied by tufted hair folliculitis. Only two previous accounts of tufted hair folliculitis developing in a lesion of pemphigus vulgaris have been reported. Read More

Acta Dermatovenerol Alp Pannonica Adriat 2011 ;20(1):27-9

Department of Dermatology and Venereology, Faculty of Medicine, Medical University of Sofia, Street Address, Postal code Sofia, Bulgaria.

Tufted hair folliculitis is a rare folliculitis of the scalp that resolves with patches of scarring alopecia within multiple hair tufts emerging from dilated follicular orifices. Tufting of hair is caused by clustering of adjacent follicular units due to a fibrosing process and to retention of telogen hairs within a dilated follicular orifice. Various pathogenetic mechanisms have been proposed including nevoid abnormalities, recurrent infections of the follicles, and retention of telogen hair in the tufts. Read More

Indian J Dermatol Venereol Leprol 2011 Jul-Aug;77(4):535

Skinmed 2011 May-Jun;9(3):186-8

Department of Dermatology, Second University of Naples, Naples, Italy.

A 25-year-old man presented with Touraine-Solente-Golé syndrome (primary pachydermoperiostosis), with an area of inflammatory dermatosis (12-month evolution) of the scalp at the cranial vertex. The patient presented with arthropathy, clubbing of the digits, diffuse periostosis, pachydermia of the hands and feet, and periosteal hyperostosis of the knee. Facial seborrhea and sebaceous gland hyperplasia were evident (Figure 1A and 1B and Figure 2A and 2B). Read More

G Ital Dermatol Venereol 2011 Apr;146(2):164-5

J Cutan Pathol 2011 Jul 14;38(7):595-6. Epub 2011 Mar 14.

Target Oncol 2010 Dec 15;5(4):295-6. Epub 2010 Oct 15.

Division of Dermatology, Washington University School of Medicine, 660 S. Euclid, Campus Box 8123, St. Louis, MO 63110, USA.

Chemotherapeutic agents targeting the human epidermal receptor (HER) family are being used with increasing frequency for a variety of solid tumors. Cutaneous side effects are commonly reported with HER inhibitors, especially those agents that inhibit epidermal growth factor receptor (EGFR) or HER1. However, inhibitors of HER2 are not associated with specific skin toxicity. Read More

Clin Exp Dermatol 2009 Dec 29;34(8):e699-701. Epub 2009 Jul 29.

Department of Dermatology, Second University of Naples, Naples, Italy.

We report a case of tinea capitis mimicking tufted hair folliculitis in a 56-year-old European man, who presented with a 4-year history of pain and erythema in an area of scarring alopecia of the occipital scalp, with scales and tufts of hair emerging from individual follicles. Histological examination showed hair plugging, and a dense perifollicular infiltrate of plasma cells, lymphocytes, and neutrophils. There was widespread scarring and fibrosis. Read More

Clin Exp Dermatol 2008 Nov 4;33(6):790-1. Epub 2008 Jul 4.

J Eur Acad Dermatol Venereol 2009 Jan 1;23(1):87-9. Epub 2008 Apr 1.

Am J Clin Dermatol 2008 ;9(2):137-40

Ayza Skin & Research Center, Lalamusa, Pakistan.

Keratosis follicularis spinulosa decalvans is a rare, X-linked disorder characterized by scarring alopecia of the scalp and eyebrows in the setting of widespread keratosis pilaris. Less frequent associations are ocular abnormalities and palmoplantar keratoderma. Acne keloidalis nuchae has previously been described in one patient with keratosis follicularis spinulosa decalvans. Read More

J Eur Acad Dermatol Venereol 2006 Feb;20(2):227-9

J Am Acad Dermatol 2005 Apr;52(4):637-43

University of California, San Francisco, San Francisco, California, USA.

Background: Primary cicatricial alopecias encompass a group of disorders characterized by permanent destruction of the hair follicle. The varied clinical features and differences in terminology have led to difficulties in defining consistent clinicopathologic correlation.

Objective: We sought clinicopathologic correlation of 6 clinically distinct primary cicatricial alopecias: lichen planopilaris, frontal fibrosing alopecia, pseudopelade (Brocq), central centrifugal alopecia, folliculitis decalvans, and tufted folliculitis. Read More

J Dermatolog Treat 2004 Dec;15(6):396-8

University of Rome La Sapienza II, School of Medicine, Department of Skin and Sexually Transmitted Diseases, Italy.

Background: A 47-year-old woman presented with erythematous lesions with papules and pustules on her parieto-occipital region that had been present for 8 months. Areas of sclero-atrophic alopecia were evident, whereas at different points tufted hair shafts were coming out from single dilatated follicular ostia. Before our observation, an antibiotic oral therapy with tetracyclines and local with erythromycin had been administered to the patient, with partial improvement and relapse on its suspension. Read More

Plast Reconstr Surg 2004 Oct;114(5):1339-41

J Eur Acad Dermatol Venereol 2003 Mar;17(2):223-6

Department of Dermatology, University of Heidelberg, Germany.

Tufted hair folliculitis (THF) is a rare disease which is characterized by the emergence of multiple hairs from widely dilated follicular orifices surrounded by an inflammatory infiltrate resulting in scarring alopecia. The pathogenesis is not yet fully understood. Although colonization with Staphylococcus aureus could not always be detected and systemic treatment with antibiotics alone is not sufficient, this microorganism is considered to play an important role. Read More

J Dermatol 2002 Jul;29(7):427-30

Division of Dermatology, Holy Spirit Hospital, Nagoya, Aichi, Japan.

A 35-year-old man developed red papules and plaques with alopecia and hair tufts on the parietal and occipital areas of his scalp. Each tuft was comprised of 5 to 25 hairs arising from individual hair follicules. Histopathological findings showed a dense infiltration of plasma cells in the dermis. Read More

Saudi Med J 2001 Feb;22(2):174-5

Al-Badreyah Medical Tower, Jeddah, Kingdom of Saudi Arabia.

Cutis 2001 Mar;67(3):243-5

Department of Dermatology and Venereology, Hospital de São João, Porto, Portugal.

We describe the case of a 38-year-old epileptic man with tufted hair folliculitis. The condition started 5 years ago after a scalp laceration that had been sustained 3 months earlier during an epileptic crisis. There then appeared a circumscribed inflammatory bulging lesion (with exudation and crusts) that evolved to scarring alopecia with tufts of 20 to 30 apparently normal hair shafts. Read More

Eur J Dermatol 1999 Oct-Nov;9(7):581-2

Department of Dermatology and Venereology, Otto-von-Guericke-University, Magdeburg, Germany.

Eur J Dermatol 1999 Jun;9(4):276-7

Department of Dermatology, Koto hospital, 6-8-5 Ojima, Koto ku, Tokyo 136, Japan.

Tufted hair folliculitis (THF) is a relatively rare disorder. We report two typical cases of THF, which are the first cases from Japan reported in the international literature and we discuss a new effective treatment for this condition. Read More

J Am Acad Dermatol 1999 Jul;41(1):112-4

Institute for Dermatopathology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

We present a patient with pemphigus vulgaris who, over the years, experienced the development of tufted hair folliculitis as a result of scalp involvement. Multiple hairs emerged from widely dilated follicular ostia surrounded by indurated, scarred skin. Histopathologic findings were typical for tufted hair folliculitis. Read More

Br J Dermatol 1999 May;140(5):975-6

Br J Dermatol 1999 Feb;140(2):328-33

Departments of Dermatology and Cellular Science, The Oxford Radcliffe Hospital, Oxford OX3 7LJ, U.K.

In a series of 18 patients with folliculitis decalvans attending the Oxford hair clinic, eight were found to have areas of tufted folliculitis either at presentation or follow-up. There was no difference between these two groups in their presentation, clinical course, growth of causative organism (Staphylococcus aureus) or investigations including histology. We suggest that these two entities form part of a spectrum of a single disease. Read More

Br J Dermatol 1998 May;138(5):799-805

Department of Dermatology and Dermatopathology, Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy.

Tufted folliculitis is an uncommon folliculitis of the scalp that resolves with patches of scarring alopecia within which multiple hair tufts emerge from dilated follicular orifices. The clinicohistological data from a group of 15 patients with tufted folliculitis were reviewed and compared with those of seven patients with folliculitis decalvans, five with acne keloidalis nuchae, four with dissecting cellulitis of the scalp, three with kerion celsi and 20 with follicular lichen planus. It was found that tufted folliculitis could be differentiated from folliculitis decalvans only by finding several hair tufts scattered within patches of scarring alopecia. Read More

J Am Acad Dermatol 1998 May;38(5 Pt 2):857-9

Department of Dermatology, Tohoku University School of Medicine, Sendai, Japan.

We describe tufted hair folliculitis that developed in a chronically erosive plaque on the scalp of a Japanese man patient with pemphigus vulgaris. After repeated intralesional corticosteroid injections, the erosive lesion improved, leaving multiple hairs emerging from single follicular openings. The current case suggests that localized exudative inflammatory lesions in the scalp regardless of cause can result in tufted hair formation. Read More

Hautarzt 1997 Apr;48(4):266-9

Dermatologische Klinik, Universitätsspital, Zürich.

A case of tufted hair folliculutis presenting as circumscribed, tender and inflamed areas in the occiput with residual tufted follicles in a 28-year old man is reported. Tufted hair folliculitis is a characteristic localized scarring bacterial folliculitis of the scalp due to Staphylococcus aureus. Histopathological studies reveal perifollicular inflammation around the upper portions of the follicles sparing the hair root level. Read More

Dermatology 1997 ;194(1):71-3

Department of Medical-Surgical Dermatology and Venerecology, Hospital Universitario Virgen Macarena, Faculty of Medicine, University of Seville, Spain.

Acne keloidalis nuchae is a chronic, scarring folliculitis that affects mostly black patients and is located on the back of the neck of young adults. The course is progressive and leads to hypertrophic scarring, chronic abscesses and hair loss. We discuss the relationship between acne keloidalis and tufted hair folliculitis, pointing out the possibility that tufted hair folliculitis is not a specific disease but secondary to other progressive folliculitis like folliculitis decalvans, dissecting cellulitis or acne keloidalis. Read More

Int J Dermatol 1996 Apr;35(4):280-1

Department of Dermatology, King Hussein Medical Center, Amman, Jordan.

Br J Dermatol 1994 Feb;130(2):259-60

Ann Dermatol Venereol 1994 ;121(6-7):479-81

Service de Dermatologie, Hôpital de l'Antiquaille, Lyon.

Introduction: Tufted hair folliculitis is a localized scarring bacterial folliculitis due to Staphylococcus aureus. We present two cases.

Observations: Both patients were in their thirties. Read More

Ann Dermatol Venereol 1994 ;121(4):319-21

Clinica Dermatologica, Ospedale Umberto I, Ancona.

We observed a case of folliculitis decalvans involving the beard and the scalp with a tufted hair folliculitis aspect in the occipital region. The presence of two clinical presentations in the same patient has not been reported in the literature. This would suggest that the two entities could be morphological aspects of the same pathological process which might cause either atrophy with loss or the annexes or tufted hair folliculitis depending upon the depts and destructive capacity of the inflammatory process. Read More

Br J Dermatol 1993 Apr;128(4):454-7

Service of Dermatology, Hospital General Vall d'Hebron, Barcelona, Spain.

Clin Exp Dermatol 1991 May;16(3):199-201

Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

A 21-year-old man presented with an erythematous pruritic plaque on the right parietal scalp of 2 years' evolution. Physical examination disclosed multiple bundles of hairs emerging from single dilated follicular openings. The disorder followed a relapsing and progressive course, in spite of several topical and systemic treatments. Read More

Am J Dermatopathol 1990 Feb;12(1):37-41

Department of Dermatology, Slade Hospital, Oxford, England.

Residual groups of hair follicles and unusual "tufts" of multiple hairs emerging from single follicular openings have been described in scarring alopecia associated with staphylococcal infection. Various mechanisms have been proposed to explain these findings. Histological study of four cases suggests that retention of telogen hairs through several hair cycles may be responsible for this phenomenon. Read More

J Am Acad Dermatol 1989 Nov;21(5 Pt 2):1096-9

Department of Pathology, Harvard Medical School, Boston, MA.

A case of scarring alopecia presenting as two circumscribed, tender and inflamed areas in the occiput with residual tufted follicles is reported. Each tuft comprised 10 to 15 normal-appearing hairs arising from individual hair follicles in the reticular dermis or subcutaneous fat, converging toward a single orifice in the epidermis. The initial pathologic finding was inflammation and scarring of the papillary and mid dermis with almost total sparing of the hair follicles in the subcutaneous fat. Read More