Hoffmann’s perifolliculitis is a chronic dermatological disease of purulent–inflammatory nature. It is quite rare. Symptoms of this pathology are superficial and deep abscesses on the hairy parts of the body – mainly on the head, occasionally the armpits and pubic area may be affected. Diagnosis of Hoffmann’s perifolliculitis is based on the results of dermatological examination, histological examination of the affected tissues, general analyses and bacteriological studies. Antibacterial agents (antibiotics, sulfonamides), immunostimulating drugs (including anatoxins), supportive therapy (vitamins, biogenic stimulants) are used to treat the disease.
Hoffmann’s perifolliculitis (abscessing undermining folliculitis) is a rare chronic skin disease characterized by the formation of purulent–inflammatory foci in areas of the body with developed hair. Such a condition has been known for a long time, but the German dermatologist Hoffmann first became the compiler of its detailed description in 1907. Hoffman identified the pathology as a result of infection of peripheral tissues with bacteria from the staphylococcus group. Hoffmann’s perifolliculitis is a rare dermatological condition, its frequency among the population is currently unknown. This disease affects men much more often, the ratio of male and female patients is 5:1. In addition to the actual inflammatory symptoms, Hoffmann’s perifolliculitis leads to persistent focal alopecia, therefore, with the localization of pathological foci on the scalp, it can cause pronounced aesthetic discomfort. In some cases, areas of baldness bother patients more than other symptoms of pathology.
Since the time of careful study of this condition by E. Hoffman and until recently, pathogenic staphylococcal flora was considered the only cause of the development of abscessing undermining folliculitis. The fact that Hoffmann’s perifolliculitis is a rather rare condition did not fit into this point of view, whereas other forms of inflammatory skin lesions with staphylococci are common. Currently, it has been found out that not only infection with microorganisms plays a role in the development of the disease, but also the physiological characteristics of human skin. They allow bacteria to colonize the dermis tissue around the hair roots, thereby provoking the development of Hoffmann’s perifolliculitis.
The main feature of the skin, found in almost all patients with Hoffmann’s perifolliculitis, is a change in the nature of the secretion of the sebaceous glands, which eventually leads to their blockage (occlusion). A similar mechanism is implemented in many dermatological conditions, for example, comedones and acne. However, for the development of Hoffmann’s perifolliculitis, a pathological reaction of the skin to the components of the decay of clogged sebaceous glands, mainly keratin, is also necessary. Modern studies have confirmed that patients with this pathology form a granulomatous inflammatory reaction to keratin breakdown products, which is aggravated by infection with staphylococcal flora. These processes, as well as microcirculation disorders in the dermis and other dystrophic manifestations lead to the appearance of Hoffmann’s perifolliculitis.
The disease more often affects men and occurs in areas of the body with developed hair, primarily on the head. Usually Hoffman’s perifolliculitis develops at the age of 20-35 years, the onset of the disease may be accompanied by severe itching and burning, when examining the skin, foci of redness are detected. When the scalp is affected, such changes are most often found in the parietal and occipital regions, foci often have multiple character. In rare cases, areas of perifolliculitis cover most of the head, and the unchanged tissues between them have the appearance of narrow strips. Then, in place of the spots, oblong or hemispherical nodes are formed, surrounded by areas of hair loss.
With the further course of Hoffmann’s perifolliculitis, the nodes transform into fistulas 1-2 centimeters in size, when pressed, pus is released from them, sometimes with an admixture of blood. Nodes and fistulas can ulcerate, the skin around them becomes thinner, alopecia spreads by 1-2 centimeters around the skin formations. In the absence of treatment for Hoffmann’s perifolliculitis, the nodes persist for several weeks, after which healing occurs with the formation of pronounced scars. Focal alopecia, as a rule, does not disappear, in addition, the formation of new nodes and abscesses occurs. The disease takes a long recurrent course, its duration in some cases is several years.
To determine Hoffman’s perifolliculitis, a dermatological examination, a microbiological examination of the excretory abscesses and a histological examination of the tissues in the lesions are performed. On examination, foci of alopecia are detected (more often on the head, less often in the armpits and inguinal region), spots or nodes of red color, often with ulceration. When pressing on abscesses, pus is released, often with an admixture of blood. There is also an increase in regional lymph nodes (cervical, occipital, inguinal, axillary) and an increase in body temperature, patients may complain of general malaise.
During the bacteriological study of purulent discharge (sowing on nutrient media), the purulent staphylococcal flora is usually determined. As part of this study, it is also possible to determine the sensitivity of the pathogen to various antibiotics in order to select the optimal treatment for Hoffmann’s perifolliculitis. A general blood test, as a rule, indicates the presence of nonspecific signs of purulent inflammation. Leukocytosis with a neutrophil shift to the left and a sharp increase in the rate of erythrocyte sedimentation (ESR) are detected. The histological picture in Hoffmann’s perifolliculitis is a sharp edema of the dermis and epidermis with pronounced infiltration of tissues (mainly neutrophilic in nature), the presence of signs of granulomatous inflammation, partial destruction of the basement membrane.
The main principles of therapy for Hoffmann’s perifolliculitis are the fight against staphylococcal infection, normalization of metabolic processes in the skin and correction of the secretory function of the sebaceous glands. To eliminate bacterial infection, antibiotics are used – either of a broad spectrum of action, or those to which this microorganism is most sensitive (this is detected by bacteriological studies). In addition to antibiotics, in some cases, chemotherapeutic antibacterial agents are used, for example, sulfonamides. When toxigenic strains of staphylococcus are detected (this form of perifolliculitis is manifested by pronounced general disorders), immune preparations are prescribed – serums and staphylococcal toxoid. Locally, various antiseptic ointments and solutions are used for Hoffmann’s perifolliculitis – aniline dyes and chlorhexidine, which accelerate healing and prevent the formation of new foci of the disease.
In some cases of Hoffmann’s perifolliculitis, abscesses are located in sufficiently deep layers of the skin, which requires their surgical opening, drainage and further washing with antiseptics. To normalize the sebaceous glands, retinoids, vitamin E and other means are used. Mineral and vitamin complexes and iron preparations are also necessary to increase the body’s defenses and neutralize the side effects of antibiotic therapy. Some physiotherapeutic procedures – ultraviolet irradiation, UHF and others – also have a positive effect on Hoffmann’s perifolliculitis.
Prognosis and prevention
With proper treatment and the implementation of all the recommendations of the specialist, the prognosis of Hoffmann’s perifolliculitis is relatively favorable. Relapses of the disease are possible, since it is caused not so much by infection as by the patient’s own physiological characteristics of the skin. After the healing of pathological foci of Hoffmann’s perifolliculitis, areas of cicatricial focal alopecia remain on the hairline, which are a noticeable aesthetic defect. This can be corrected only by methods of plastic surgery, no conservative or cosmetic measures restore hair growth on scar tissue. To prevent Hoffman’s perifolliculitis, it is necessary to provide the body with the necessary vitamins (especially A and E), avoid significant greasing of the hair, adhere to the rules of personal hygiene.