Hair follicular units on the human scalp consist of two or four terminal follicles and one or two vellus follicles. Generally, human hairs emerge singly from their follicles. However, in chronic pyogenic conditions such as folliculitis decavans or folliculitis keloidalis, multiple hairs can be noted and termed as THF. These lesions may result in permanent and irreversible scarring alopecia. THF occurs in both genders, with male-female ratio of 2.7:17. Patients are usually between the ages of 19 and 68 years, and the lesion is usually confined to the parietal and occipital areas.
The cause of THF is unknown, however, several pathogenetic mechanisms have been proposed to explain the development of tufted folliculitis, including naevoid abnormality, retention of telogen hair in the tufts and infective folliculitis leading to the destruction of the upper part of the follicles with the formation of a common channel. However, Pujol et al. suggests that THF may be a nonspecific secondary phenomenon that may occur in several exudative inflammatory diseases, such as dissecting cellulites of the scalp and folliculitis keloidalis. Cialis Jelly
As the THF has a characteristic finding of hairs and a unit, we proposed that magnifying the view of the lesion could be an alternative method for the diagnosis of THF. We evaluated the lesion using the phototrichogram, which is very useful to investigate hair biology. The computerized hand-held phototrichogram is used in many clinical researches because it can effectively calculate the average hair density, hair thickness and linear hair growth rate. In our patient, using the phototrichogram, we got a magnified view of the lesion and easily calculated the number of hairs emerging from a single opening (Fig. 3). We also calculated the density and the result showed a higher density than the normal control’s. There is a limitation in this report in that only one patient has been evaluated and the result cannot suggest the diagnostic densities of THF.
For treatment, systemic antibiotics and corti- costeroids can suppress the inflammatory response, but produce only slight improvements and no lasting effects after the treatment stops. Treatment of this relapsing condition leading to progressive scarring alopecia has been notoriously difficult. In our case, we gave the patient oral steroid and oral antibiotics, for these drugs have anti-inflammatory effects. Nevertheless, these drugs were not able to change the course of the disease. Therefore we undertook the surgical excision of the scarring alopecia.
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We report a case of THF showing a ‘dolly hair’ appearance with the histopathologic and phototri- chogramical findings.