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The FP cultured the pus and it grew methicillin-resistant Staphylococcus aureus; a punch biopsy around an inflamed follicle revealed that this was a case of folliculitis decalvans.
Folliculitis decalvans is a chronic painful neutrophilic bacterial folliculitis characterized by bogginess or induration of the scalp with pustules, erosions, crusts, and scale. It has been suggested that this results from an abnormal host response to S aureus, which is often cultured from the lesions. (In one case series, the disease ran a protracted course with temporary improvement while the patient was on antibiotics, but a flare-up of the disease occurred when the antibiotics were stopped.)
One or 2 punch biopsies are needed to diagnose most forms of scarring alopecia. If 2 punch biopsies are performed, ask the pathologist to cut one vertically and the other horizontally to get the most information about the disease process.
Purulent scalp lesions should be cultured and treatment directed to the predominant pathogen (most commonly S aureus). Oral rifampin 600 mg daily is given for 10 days along with 10 weeks of another antibiotic. This may include oral clindamycin 300 mg twice daily, cephalexin 500 mg 4 times daily, or doxycycline 100 mg twice daily.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Scarring alopecia. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:815-818.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
The Color Atlas of Family Medicine is also available as an app for mobile devices. See
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The FP cultured the pus and it grew methicillin-resistant Staphylococcus aureus; a punch biopsy around an inflamed follicle revealed that this was a case of folliculitis decalvans.
Folliculitis decalvans is a chronic painful neutrophilic bacterial folliculitis characterized by bogginess or induration of the scalp with pustules, erosions, crusts, and scale. It has been suggested that this results from an abnormal host response to S aureus, which is often cultured from the lesions. (In one case series, the disease ran a protracted course with temporary improvement while the patient was on antibiotics, but a flare-up of the disease occurred when the antibiotics were stopped.)
One or 2 punch biopsies are needed to diagnose most forms of scarring alopecia. If 2 punch biopsies are performed, ask the pathologist to cut one vertically and the other horizontally to get the most information about the disease process.
Purulent scalp lesions should be cultured and treatment directed to the predominant pathogen (most commonly S aureus). Oral rifampin 600 mg daily is given for 10 days along with 10 weeks of another antibiotic. This may include oral clindamycin 300 mg twice daily, cephalexin 500 mg 4 times daily, or doxycycline 100 mg twice daily.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Scarring alopecia. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:815-818.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
The Color Atlas of Family Medicine is also available as an app for mobile devices. See
|
|
The FP cultured the pus and it grew methicillin-resistant Staphylococcus aureus; a punch biopsy around an inflamed follicle revealed that this was a case of folliculitis decalvans.
Folliculitis decalvans is a chronic painful neutrophilic bacterial folliculitis characterized by bogginess or induration of the scalp with pustules, erosions, crusts, and scale. It has been suggested that this results from an abnormal host response to S aureus, which is often cultured from the lesions. (In one case series, the disease ran a protracted course with temporary improvement while the patient was on antibiotics, but a flare-up of the disease occurred when the antibiotics were stopped.)
One or 2 punch biopsies are needed to diagnose most forms of scarring alopecia. If 2 punch biopsies are performed, ask the pathologist to cut one vertically and the other horizontally to get the most information about the disease process.
Purulent scalp lesions should be cultured and treatment directed to the predominant pathogen (most commonly S aureus). Oral rifampin 600 mg daily is given for 10 days along with 10 weeks of another antibiotic. This may include oral clindamycin 300 mg twice daily, cephalexin 500 mg 4 times daily, or doxycycline 100 mg twice daily.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Scarring alopecia. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:815-818.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
The Color Atlas of Family Medicine is also available as an app for mobile devices. See