Acne triad: Description, Causes and Risk Factors:
Alternative Name: Hidradenitis suppurativa, perifolliculitis abscedens et suffodiens, dissecting cellulitis.
Acne triad is a type of scarring hair loss that presents with pustules, boggy swelling, and sinuses within the scalp.
The cause of acne triad is not known. It is associated with severe cystic acne known as acne conglobata, and Hidradenitis suppurativa, which causes cystic swelling in the armpits and groin. In all of these conditions the hair follicle becomes blocked, dilates and ruptures, this cause an inflammatory response to the skin, which leads to pus formation, swelling, and sinus formation. It is not uncommon for bacteria to be isolated from the skin but this is likely to be secondary to the inflammatory process.
Acne triad is most commonly seen in Afro-Caribbean men but the racial predilection is most likely due to the shape and structural difference of Afro-Caribbean hair than a genetic predisposition to the condition. Hair care practices, such as clipping may also play a role. It is not thought to be inherited.
Acne triad is characterized by a localized area of hair loss, pustules, boggy swelling, and sinus formation. Gentle pressure on the boggy area may led to expression of pus or serous fluid. The swelling on the scalp lead to an undulating appearance with patchy hair loss.
Differential diagnosis may include Staphylococcal folliculitis, centrifugal scarring alopecia, Pseudopelade of Brocq, tinea capitis, folliculitis decalvans, discoid lupus.
The diagnosis is often made clinically. A culture and scrapings can be done to rule out bacterial and fungal infection, respectively. A scalp Biopsy can also be performed if the diagnosis is in doubt.
When hair follicles have been destroyed they can not re-grown. The hair loss is therefore irreversible. The condition is often persistent. There are treatments aimed at both stopping further destruction of the hair follicles and decreasing pain and pustule formation.
Acne triad is a difficult condition to treat but it can be controlled with topical treatment and tablets. The evidence of for any of the treatment in this condition is poor.
Isotretinoin: This derivative of vitamin A is used commonly for severe acne. It can be useful in this condition but requires consultant supervision. This drug can control this condition but it frequently relapses on stopping.
Antimicrobials: Anti-septic washes, combined with topical anti-bacterial treatments can be beneficial. Oral antibiotics are required in addition to this in most patients. Commonly used drugs include tetracycline based antibiotics (as used in acne) and combinations of antibiotics such as rifampicin and clindamycin.
Topical Steroids: In addition to antimicrobials, topical steroids in the form of lotions, gels or mousses can help control the condition.
Systemic Steroids: Prednisolone can be helpful in calming this condition when it is very inflamed. Unfortunately long term steroid use is associated with a number of side effects which limits it's role in this condition.
Dapsone: This anti-lepromatous drug is useful for a number of dermatological conditions including dissecting cellulitis. It can cause the blood count to drop but otherwise it is well tolerated.
Anti-TNF-) Tumour necrosis factor ) is associated with a number of inflammatory conditions including hidradenitis suppurativa and dissecting cellulitis. Drugs that block or inhibit TNF ) have been shown to be very useful in hidradenitis and a few reports suggest they may be beneficial in dissecting cellulitis. More studies are needed.
Note: Risk and benefits of the medications must be discussed with your PCP.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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