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4.2. Acne necrotica

188 Hair and Scalp Disorders

4.3. Erosive pustular dermatosis

reduce the inflammation significantly [1, 85].

5. Conclusion

tive since disease etiology includes actinic damage [86, 87].

Acne necrotica is also known as folliculitis necrotica. It is a mysterious disease not understood by many dermatologists. Infections are routinely mentioned in its etiology but evidence cannot be demonstrated. Drugs and food allergies are also thought to be the cause. Mechanical factors such as itching only spread the disease. Most of patients are women. Lesions are generally observed on the scalp along face and hairline. They are rarely occurred on nose and cheeks [4, 81, 82]. Initial lesions are umbilicated follicular papules. Not long after, they transformed into pustules. Consequently, varioliform scars may develop. Initially perivascular and perifollicular lymphocytic infiltrate, subepidermal edema is apparent. In the advanced stages, necrosis is observed in the follicular epithelium and epidermis [3, 81]. Neutrophiles can be seen in superficial dermis. Differential diagnosis should also include folliculitis decalvans,

dissecting folliculitis, colitis, eczema herpeticum, and molluscum contagiosum [81, 82].

Treatment with oral tetracycline, antistaphylococcal antibiotics may be effective. They should be used in long term. In patients not having complete response, topical or intralesional corticosteroid can be added. Isotretinoin treatment may prolong the remission period [4, 43].

The disease was first described in 1979 by Pye et al. and about 100 cases have been reported so far [83]. The disease most commonly occurs in elderly and females. Sun damage, local trauma (surgery, cryotherapy, herpes zoster), and autoimmunity are blamed in its etiology. Lesions with crusts and pustules on atrophic skin are clinically observed. The number of pustules can vary remarkably, and in some cases they are absent. Pain and pruritus in the lesions are not observed. However, cicatricial alopecia may develop in the advanced stages. Histopathology is uncharacteristic and not very helpful in confirming the diagnosis [84, 85]. Histopathological examination is crucial to exclude other diseases. Histopathology shows subcorneal pustules, epidermal atrophy, and erosions. In addition, these findings can be accompanied by a polymorphous dermal inflammatory infiltrate and in some cases leukocytoclastic vasculitis might be present. The differential diagnosis should consider tinea capitis, Gram-negative folliculitis, pyoderma gangrenosum, DLE, pemphigus vulgaris, and SCC. High-potency topical steroids

Steroids must be used more than 6 months for better responses. Other treatment options include tacrolimus, dapsone, calcipotriol, and acitretin. Sun protection is reported to be effec-

Cicatricial alopecia forms an important group of disorders that end up with scarring and persistent hair loss. An elaborate physical examination, skin biopsies and blood tests can be helpful in order to establish the accurate diagnosis and to suggest the most appropriate treatment for the hair loss. Many patients do not respond to the first treatment they receive and the condition frequently relapses when treatment is stopped. Some clinics offer Ibrahim Halil Yavuz\*, Goknur Ozaydin Yavuz and Serap Gunes Bilgili

\*Address all correspondence to: ihalilyavuz@gmail.com

Department of Dermatology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
