A 36-year old woman presented with an inflammatory swollen patch of the scalp of 8 months duration (Fig. 1). The patient was said to have been treated with topical and systemic antibiotics at local clinics, but the condition worsened with peripheral extension of inflammation.
Physical examination revealed within a 5 x 6 cm sized tender area, scattered tufts composed of 7 to 15 hairs emerging from a single follicular ostia. Slight pressure on the perifollicular areas resulted in the discharge of purulent materials through the dilated follicular openings. Both KOH staining and fungal culture were negative. Staphylococcus aureus was not isolated from the affected area. canadian pharmacy viagra
Fig. 1. (A) A doll. Bundles of hairs emerging from single openings, (B), (C). A 36-year old patient. Several hair tufts are present within swollen patch giving a ‘dolly hair’ appearance as seen in Fig. 1(A).
Histopathology of the affected areas confirmed the diagnosis of tufted hair folliculitis, with addito- nal findings of a widened follicular infundibulum, dense perifollicular inflammatory cell infiltrations and dermal fibrosis in the upper dermis. In the lower dermis, there were less inflammatory cells with intact hair follicular units. In a single follicular orfice, several hairs were emerging (Fig. 2).
Fig. 2. Serial sectional views. (A). Convergence of independent hair structures towards a single orfice in the epidermis (H&E, x 40), (B). Widened follicular infundibulum and perifollicular inflammation in deeper dermis (H&E, x 40).
We evaluated the lesion with a computerized hand-held phototrichogram system (Folliscope®, LeadM Corporation, Seoul, Korea). The phototri- chogram system was applied to the central area of the lesion for measurement after shaving with a blade. We easily calculated the average hair density of the lesion (354/cm2 in tufted hair folliculitis, 106 ± 23/cm2 in average normal control). We could easily obtain the quantitative data of the hair of THF without pulling out the hair, using the computerized hand-held phototrichogram system (Fig. 3). viagra jelly
Fig. 3. (A). Within a extended bald patch, scattered follicular openings are shown (phototrichogram, magnification of x 30), (B). 5-10 normal looking hairs are arising from a common follicular ostium (phototri- chogram, magnification of x 60), (C). Automatically calculated hair density in x 60 magnification (phototrichogram, magnification of x 60).
We treated the patient with oral antibiotics (Cefditoren Pivoxil, Cephalosporin 3rd generation), oral steroids (Triamcinolone) and topical steroid (Prednicarbate 0.25%) for 5 months. The affected lesion was improved leaving scarring alopecia. For scar contracture release, surgical excision of scarring alopecia was performed with a blade and no recurrence was found after 18 months.