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By Lawrence A. Schiffman, DO, and Stephen
M. Schleicher, MD
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CASE:
A 25-year-old African-American man presents with a chronic
scalp condition. He has been treated with numerous oral antibiotics
in the past without success. He complains of discomfort,
pimple formation, drainage, and bleeding of the mid- and
posterior scalp. Physical examination finds dusky erythema
accompanied by follicular papules and pustules, as well as
evidence of scarring alopecia. Some areas are tender to palpation
and exhibit slight purulence.
WHAT IS YOUR DIAGNOSIS?
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Folliculitis decalvans is a scarring alopecia associated with
chronic infection of the scalp. Culture most commonly reveals
growth of Staphylococcus aureus, although response to antibiotics
is variable. The pronounced inflammatory infiltrate destroys
the hair follicle, leading to scar formation and permanent
hair loss within the involved areas. A 10-week course of
therapy combining oral rifampin and oral clindamycin proved
helpful in this case. |
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Dr. Schleicher is director of DermDx Centers
and a clinical instructor of dermatology at the Philadelphia
College of Osteopathic Medicine, at Kings College in Wilkes-Barre,
Pennsylvania, and at Arcadia University in Glenside, Pennsylvania.
He is also a member of the emergency medicine editorial board.
Dr. Schiffman is currently a resident at
St. John's Episcopal Hospital in Far Rockaway, New York.
Dr. Jabr is
an internist at HealthAssociates of Peace Harbor in Florence,
Oregon.
Emerg Med 38(11):57-8, 2006
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