Establishment of the Diagnosis of Follicular Occlusion Tetrad.

Abstract

Aulia Rahman, Nugrohoaji Dharmawan, Nurrachmat Mulianto, Prasetyadi Mawardi, Indah Julianto, Priyambodo, Mahmud Ghaznawie and Suci Widhiati

Background: Follicular occlusion tetrad (FOT) is a clinical syndrome consisting of suppurative hidradenitis, acne conglobata, dissecting cellulitis of the scalp, and pilonidal sinus. FOT is a rare case that is mostly found in severe conditions resulting in resistance to therapy. Diagnostic accuracy and therapy for all components of FOT is extremely important. Case: A 43-year old male presented with small, painful blisters and bumps filled with pus that had been ongoing for five years. We found pustules and erythematous nodules and multiple abscess with atrophic scars on the scalp, anterior and posterior trunks, abdomen, groin and gluteal regions on the facial region, we found multiple atrophic scars. The pus culture showed the presence of Escherichia coli, and fistulography examination revealed multiple cutaneous fistules and enterocutaneous sinus. The histopathological examination indicated rupture of hair follicles, follicular plugs, and infiltration of heavy-mixed infiltrate cells.
Discussion: The FOT diagnosis was established through medical history recording, physical and histopathological examinations, and fistulography. Upon medical history recording and physical examination, we found pustules and nodules in several hairy areas. The fistulographic examination showed some fistules and sinus tracts, and the histopathological examination showed adnexal tissue damage caused by occlusion of hair follicles and inflammation due to accumulation of keratin and debris. All these findings led to the FOT diagnosis.

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