Folliculitis decalvans

QUESTION 44

A 58-year-old African American man presents to the Veterans Affairs (VA) dermatology clinic for evaluation of recurrent pustules on the scalp and hair loss. This has been ongoing and progressive over the last 10 years. He reports associated scalp symptoms of pruritus, itching, tenderness and burning. He occasionally develops large pus-filled nodules with drainage, with bacterial cultures growing Staphylococcus aureus in the past. On examination, there are scattered papules coalescing into plaques on the parietal scalp with areas of patchy, scarring alopecia, with loss of follicular ostia and increased interfollicular distance (44). Two 4-mm punch biopsies are performed, which demonstrates dense perifollicular inflammation in the upper portion of the hair follicles with a mixed inflammatory infiltrate consisting of lymphocytes, neutrophils and plasma cells.

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