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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 39  |  Issue : 2  |  Page : 102-104

Dermoscope as a diagnostic tool in pseudofolliculitis corporis: a dermatologist’s viewpoint


1 Department of Dermatology, Venereology and Leprology, Government Medical College, Amritsar, Punjab, India
2 Department of Dermatology, Venereology and Leprology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India

Date of Submission10-Feb-2019
Date of Acceptance11-Apr-2019
Date of Web Publication03-Jul-2019

Correspondence Address:
Chetna Singla
Department of Dermatology, Venereology and Leprology, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Amritsar, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejdv.ejdv_6_19

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  Abstract 


Pseudofolliculitis is an inflammatory condition of the hair follicle that mainly affects the beard area, but it can occur in any area of hair-bearing skin when hair removal methods like shaving or plucking are used. It occurs when the shaved hair curls inwards and repenetrates the skin surface inducing inflammatory changes. Sometimes, it is a simple cosmetic problem, but at other times it can present with intense itching or pain and can become quite debilitating for the patient. Here, we report a case of pseudofolliculitis corporis presenting to us with intractable itching. The patient used to rub his back against the wall and used combs and other things for itching. The diagnosis of pseudofolliculitis corporis was suspected clinically and confirmed by dermoscopy, which is a simple office procedure. Patient was advised not to rub his back against wall and was given emollients and topical adapalene gel and advised follow-up after 15 days.

Keywords: dermoscopy, pseudofolliculitis corporis, diagnostic tool


How to cite this article:
Budhwar J, Singla C, Muralidharan E, Malhotra SK. Dermoscope as a diagnostic tool in pseudofolliculitis corporis: a dermatologist’s viewpoint. Egypt J Dermatol Venerol 2019;39:102-4

How to cite this URL:
Budhwar J, Singla C, Muralidharan E, Malhotra SK. Dermoscope as a diagnostic tool in pseudofolliculitis corporis: a dermatologist’s viewpoint. Egypt J Dermatol Venerol [serial online] 2019 [cited 2019 Sep 23];39:102-4. Available from: http://www.ejdv.eg.net/text.asp?2019/39/2/102/262040




  Introduction Top


Pseudofolliculitis is a chronic inflammatory, noninfectious disorder that occurs as a foreign body reaction to the cut tip of the hair that repenetrates the skin [1]. Pseudofolliculitis barbae is a common condition, but pseudofolliculitis corporis is not that common and perhaps mostly misdiagnosed. Submandibular area of the face is most commonly affected, but other areas such as axillae and pubic areas can also be affected where the affected curly hair can be seen emerging at an acute angle from the skin [2]. In other cases, it can also affect sites such as trunk and limbs after shaving [3]. We report one such patient with chronic pseudofolliculitis corporis who presented to us with intense itching and where dermoscope proved to be an effective tool in clinching the diagnosis.


  Case report Top


A 64-year-old male patient reported to the skin outpatient department with intractable itching over trunk, both upper limbs, and lower limbs since 2 years. The severity of itching was such that patient used to rub his back against the wall and used combs and other things for rubbing. On thorough history taking, no medical complaints like diabetes mellitus, liver disease, renal disease, or thyroid disorder were found. There was no history of any drug intake, and patient was a teetotaler. Similar symptoms were not present in any family members. On thorough clinical examination of the patient, his general physical examination was unremarkable. Mucocutaneous examination revealed that he had Fitzpatrick skin type IV. There were multiple, discrete, slightly hyperpigmented pinpoint follicular papules which were clustered over interscapular area, upper arms, and lower one-third of thighs and knees ([Figure 1]). Dermoscopy of these papules showed black coiled coarse hairs just beneath the superficial epidermis (cuticle) with mild scaling ([Figure 2]). Some of the hairs were coiled in loops with bluish tinge that represented buried hair shaft and some could be seen re-entering the skin ([Figure 3]). It was also observed that there were multiple, discrete, red colored pinpoint to pin head-sized firm papules with well-defined regular margins present over chest, abdomen, and back in a scattered manner ([Figure 1]). Dermoscopy of these lesions showed individual dilated blood vessels. Keeping in mind the history, clinical examination, and dermoscopic findings, a provisional diagnosis of pseudofolliculitis corporis with cherry angiomas was made. Patient refused histopathological examination and was given emollients and topical adapalene gel and advised follow-up after 15 days. On subsequent follow-ups, marked improvement in the lesions was seen.
Figure 1 Showing scattered follicular papules over back and (inset) showing cherry angiomas in red arrow and pseudofolliculitis papules in black arrow.

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Figure 2 Showing multiple coils of coarse hair with scaling.

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Figure 3 Showing reentry of hair with bluish color representing buried hair shaft (arrow).

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  Discussion Top


Pseudofolliculitis mainly affects the beard area where it is known as Pseudofolliculitis barbae, but it can occur in any area of glabrous skin [4]. Although the largest percentage of cases are of African origin, Caucasians and South East Asians can also be affected. The term pseudofolliculitis corporis was first used by Puhan and Sahu [5]. Pseudofolliculitis vibrissae and fiddler’s neck involve nares and neck, respectively. It occurs after traumatic hair removal such as after shaving and plucking. When the hair are cut with razor, the sharp oblique ends left behind make contact with the skin at 90° and repenetrate the skin, making a papule known as pseudofollicle [5]. The inflammation of this pseudofollicle when the repenetrated hair acts as a foreign body is called as pseudofolliculitis.

Treatment aims at reducing extrafollicular and transfollicular hair penetration and reduction of inflammation. Hair usually pulls out of the epidermis if its length increases beyond 10 mm. Treatment of pseudofolliculitis may include traditional therapies such as topical and oral antibiotics, topical tretinoin cream, topical steroids, topical eflornithine cream, chemical depilation, electrolysis, and chemical peels and more advanced methods such as laser removal which can be done with Diode laser, Nd-YAG laser, and Pulsed Infrared Laser [6],[7],[8].

There are very few case reports that focus on dermoscopic findings in pseudofolliculitis and even less that advocate use of dermoscopy as a diagnostic tool in such cases. Chuh and Zawar [9] first used dermoscope for pseudofolliculitis barbae and noticed that it could prove to be an effective tool in making the patient understand his condition and hence better compliance. In a study conducted by Kaliyadan et al. [7] on pseudofolliculitis of beard area, handle bar sign, white areas, scaling, linear bluish streaks, and linear vessels were found to be common dermoscopic features. Dermoscopy was diagnostic in our case, and our patient showed coiled hair loops and bluish colored buried hair shafts, which were also seen in studies by Puhan and Sahu [5] and Kaliyadan et al. [7]. It is an office procedure which can be done in a noninvasive manner and alleviates the need for biopsy in difficult-to-diagnose cases and hence should preferably be used routinely.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Strauss JS, Kligman AM. Pseudofolliculitis of the beard. Arch Dermatol Symphilol 1956; 74:533–542.  Back to cited text no. 1
    
2.
Ribera M, Fernández-Chico N, Casals M. Pseudofolliculitis barbae. Actas Dermosifiliogr 2010; 101:749–757.  Back to cited text no. 2
    
3.
Dilaimy M. Pseudofolliculitis barbae of the legs. Arch Dermatol 1974; 112:507–508.  Back to cited text no. 3
    
4.
Dunn JF Jr. Pseudofolliculitis barbae. Am Fam Physician 1988; 38:169–174.  Back to cited text no. 4
    
5.
Puhan MR, Sahu B. Pseudofolliculitis corporis: a new entity diagnosed by dermoscopy. Int J Trichology 2015; 7:30–32.  Back to cited text no. 5
    
6.
Kauvar ANB. Treatment of pseudofolliculitis with a pulsed infrared laser. Arch Dermatol 2000; 136:1343–1346.  Back to cited text no. 6
    
7.
Kaliyadan F, Kuruvilla J, Al Ojail HY, Quadri SA. Clinical and dermoscopic study of pseudofolliculitis of the beard area. Int J Trichology 2016; 8:40–42.  Back to cited text no. 7
    
8.
Alexis A, Heath CR, Halder RM. Folliculitis keloidalis nuchae and pseudofolliculitis barbae: are prevention and effective treatment within reach? Dermatol Clin 2014; 32:183–191.  Back to cited text no. 8
    
9.
Chuh A, Zawar V. Epiluminescence dermatoscopy enhanced patient compliance and achieved treatment success in pseudofolliculitis barbae. Australas J Dermatol 2006; 47:60–62.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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