Tufted hair folliculitis after scalp injury

We describe the case of a 38-year-old epileptic man with tufted hair follic ulitis. The condition started 5 years ago after a scalp laceration that had been sustained 3 months earlier during an epileptic crisis. There then app eared a circumscribed inflammatory bulging lesion (with exudation and crust s) that evolved to scarring alopecia with tufts of 20 to 30 apparently norm al hair shafts. Results of bacteriologic examination of pus extruding from the dilated follicular ostia revealed Staphylococcus aureus. The cutaneous pathologic examination showed polymorphous inflammatory exudate in the uppe r and mid dermis, which was mostly perifollicular, and the presence of norm al and independent follicles in the deep dermis, which, while ascending. co nverged to a common dilated follicular channel. The patient was treated suc cessively with oral flucloxacillin, erythromycin, ciprofloxacin, and amoxic illin/clavulanic acid and with topical application of erythromycin, clindam ycin, povidone iodine, and ketoconazole. Transient improvement was followed by recurrence and enlargement of the affected area.