Hoffmann's rupturing or abscessing folliculitis has been associated with acne conglobata and severe hydroadenitis (acne inversus). All three of these diseases are described by some authors as a triad of follicular occlusion.
Disruptive folliculitis is more common in adolescents and young men between 18 and 40 years of age. There is also a racial predisposition: African-American men are affected more often than Caucasians. Among women and children, the disease is extremely rare.
Follicular occlusion, seborrhea, androgenetic stimulation, secondary bacterial infection, and an abnormal immune response play a role in the pathogenesis.
Hoffman Folliculitis Clinic
Frequent localization of undermining folliculitis - vertex. Follicular pustules and papules coalesce with perifollicular pustules - firm nodules - and eventually form abscesses and fistulas. When pressed, serous-purulent contents may be separated.
Chronic relapses of the disease lead to cicatricial alopecia in the form of hypertrophic and keloid scars.
Provoking/Risk Factors for Hoffmann Folliculitis
Undermining scalp folliculitis can be accompanied by acne conglobate, supparative hidradenitis, and pilonidal cysts, together forming the follicular occlusion syndrome. There is evidence that the disease is associated with spondyloarthropathy, sternoclavicular hyperostosis, SAPHO syndrome (synovitis, acne, pustular acrodermatitis, hyperostosis, osteomyelitis), marginal keratitis, secondary squamous cell carcinoma, osteomyelitis of staphylococcal etiology, vegetative pyoderma, and Devergy's lichen pilaris.
Treatment of undermining Hoffmann's folliculitis
Systemic and topical antibiotic therapy aimed at eliminating bacterial infection is the primary goal of therapy (tetracycline, minocycline, erythromycin, cephalosporin and clindamycin show good efficacy). Another treatment option may be intralesional injections of triacinolone acetonide, zinc sulfate, dapsone, colchicine.
Intralesional corticosteroids and non-steroidal anti-inflammatory drugs may be given additionally. For long-term remission, retinoids are prescribed for a course of 6-12 months. Surgical treatment is considered only in the absence of a positive response from therapeutic treatment. They also use the method of laser hair removal with a pulsed ruby laser or a pulsed diode laser, as well as modern external beam therapy.
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