Tufted hair folliculitis after scalp injury

We describe the case of a 38-year-old epileptic man with tufted hair folliculitis. The condition started 5 years ago after a scalp laceration that had been sustained 3 months earlier during an epileptic crisis. There then appeared a circumscribed inflammatory bulging lesion (with exudation and crusts) that evolved to scarring alopecia with tufts of 20 to 30 apparently normal 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 upper and mid dermis, which was mostly perifollicular, and the presence of normal and independent follicles in the deep dermis, which, while ascending, converged to a common dilated follicular channel. The patient was treated successively with oral flucloxacillin, erythromycin, ciprofloxacin, and amoxicillin/clavulanic acid and with topical application of erythromycin, clindamycin, povidone iodine, and ketoconazole. Transient improvement was followed by recurrence and enlargement of the affected area.