STERILE NEUTROPHILIC FOLLICULITIS WITH PERIFOLLICULAR VASCULOPATHY - A DISTINCTIVE CUTANEOUS REACTION PATTERN REFLECTING SYSTEMIC-DISEASE

The authors prospectively encountered skin biopsies from 20 patients w hich demonstrated a neutrophilic or suppurative and granulomatous foll iculitis accompanied by a folliculocentric neutrophilic vascular react ion of Sweet's-like or leukocytoclastic vasculitis subtypes. While in each case the histomorphology raised diagnostic consideration of bacte rial folliculitis, patients frequently expressed systemic complaints s uch as arthritis, fever, and malaise, and special stains for micro-org anisms were negative, Among the clinical presentations were folliculit is, vasculitis, acneiform eruptions, vesiculopustular lesions, and ery thema nodosum-like lesions, with the legs, arms, and upper back being the most commonly involved sites. Nineteen patients were found to have specific underlying systemic diseases, namely, inflammatory bowel dis ease, Reiter's disease, Behcet's disease, hepatitis B, connective tiss ue disease including mixed connective tissue disease and rheumatoid ar thritis, scrofuloderma, and hematologic dyscrasias. The other patient had antecedent bacterial sinusitis in the setting of atop): The follic ulocentric nature of these lesions may reflect preferential processing of antigens through the hair follicle and/or homology between bacteri al and follicular heat shock proteins in the susceptible host, namely, one who responds excessively to exogenous antigenic triggers. Follicu litis with folliculocentric vasculopathy may be a clue to underlying s ystemic disease and/or an extracutaneous infection. Certain light micr oscopic features in concert with the clinical presentation may disting uish such cases from conventional infectious folliculitis. (C) Munksga ard 1998.