Photogallery. Follicular occlusion syndrome

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Abstract

Hidradenitis suppurativa, dissecting cellulitis of the scalp, acne conglobata and pilonidal sinus ― are four diseases united by similar clinical findings and common mechanisms of pathogenesis. These conditions often coexist. The primer pathogenetic event is stratum corneum thickening and keratin plugging of the hair follicle ductal isthmus. The discovery of this mechanism led to association of all the diseases with the term "follicular occlusion syndrome". If three nosologies are detected follicular occlusion triad is diagnosed, if four are present ― follicular occlusion tetrad.

We present a photogallery on this problem.

About the authors

Natalia P. Teplyuk

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: teplyukn@gmail.com
ORCID iD: 0000-0002-5800-4800
SPIN-code: 8013-3256
Russian Federation, Moscow

Anna S. Pirogova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: annese@mail.ru
ORCID iD: 0000-0002-2246-1321
SPIN-code: 1419-2147
Russian Federation, Moscow

Daria A. Svistunova

Saratov State Medical University named after V. I. Razumovsky

Author for correspondence.
Email: teplyukn@gmail.com
Russian Federation, Saratov

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2. Fig. 1. Patient G., 25 years old. Diagnosis: ˝Follicular occlusion syndrome. Dissecting cellulitis of the scalp. Hidradenitis suppurativa˝. The photograph shows patchy hair loss typical for the early stages of dissecting cellulitis. At this stage alopecia is potentially reversible.

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3. Fig. 2. The same patient. Single hidradenitis suppurativa abscess forming in the intergluteal fold with pointing of pustule.

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4. Fig. 3. The same patient. Trichoscopy in the patchy hair loss area: Multiple black dots, yellow 3D dots with and without hair shafts, vellus hairs, violaceous areas, white areas of fibrosis, several pili torti.

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5. Fig. 4. Patient B., 19 years old. Diagnosis: "Follicular occlusion syndrome. Hidradenitis suppurativa. Acne conglobata". The photograph presents acne conglobata with keloids as an outcome on the back, similar clinical picture can be observed on the chest and face.

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6. Fig. 5. The same patient. In hidradenitis suppurativa axillary involvement is typical. Pay attention to the scarring and the only inflammatory nodule on the left axilla in a patient with bilateral involvement, hidradenitis suppurativa in a resolution stage with less inflammatory lesions.

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7. Fig. 6. Patient S., 39 years old. Diagnosis: "Follicular occlusion triad. Hidradenitis suppurativa. Dissecting cellulitis of the scalp. Acne conglobata". Multiple interconnected sinus tracts on the scalp, associated scarring alopecia with keloid formation, which develops in cases of treatment absence in early stages.

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8. Fig. 7. The same patient. Conglobata type of hidradenitis suppurativa according to Van Der Zee and Jemec classification, 2015 (lesions in the armpits and inguinal areas are not shown in the photographs). Note the numerous double-ended pseudocomedones considered to be a typical clinical sign of hidradenitis suppurativa.

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9. Fig. 8. Patient S., 25 years old. Diagnosis: "Follicular occlusion syndrome. Hidradenitis suppurativa. Pilonidal sinus". The photograph shows hidradenitis suppurativa of the genital and perianal area with inflammatory discharging nodules, scarring from previous recurrent episodes with postinflammatory hyperpigmentation.

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10. Fig. 9. The same patient. Condition after pilonidal sinus surgery. Postoperative wound, healing by secondary intention, without signs of inflammation with granulation tissue.

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11. Fig. 10. Patient G., 37 years old. Diagnosis: "Follicular occlusion syndrome. Hidradenitis suppurativa. Pilonidal sinus". Condition before surgical retreatment of pilonidal sinus due to recurrence. A postoperative scar is visible in projection of the intergluteal fold. An area of hypergranulation tissue is determined in the lower third of the scar.

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12. Fig. 11. The same patient. The photograph shows inactive hidradenitis suppurativa in the axillary region, presented by several bridging scars as an outcome of previous inflammation.

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Copyright (c) 2023 Teplyuk N.P., Pirogova A.S., Svistunova D.A.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
 


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