Chronic non-scarring folliculitis of the scalp

Forty patients with recurrent follicular pustules of the scalp but without obvious necrosis or residual scarring were re-examined (mean 8.3 years after onset of lesions). The most common age at onset was 20-40 years. The sex ratio (M/F) was 3 : 1. Only 7 of 40 patients had concomitant acne vulgaris on the face. All patients still had active, recurring scalp lesions, although 7 out of 40 had had temporary remissions. Post-lesional scarring was not observed. Oral low-dose tetracyclines had a symptomatic effect in 7 of 11 patients. Most of the patients treated topically with steroids and alcoholic lotions experienced little or no effect. Histopathology disclosed a neutrophilic folliculitis. Bacteriological examinations showed only the usual resident microflora of the scalp with P. acnes being the most frequent species. In 3 cases (5 examined pustules), P acnes was isolated from the content of the pustules without being found on the skin surface over the pustule. Chronic non-scarring folliculitis of the scalp probably constitutes a disease entity.