Atlas of Clinical Dermatopathology E-Book

Gunter Burg

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch
• Veröffentlichungsjahr: 2020

Seitenzahl: 192

Beschreibung

Differential diagnosis is at its most accurate and efficient when clinical presentation and histopathological features are considered in correlation with one another. With that being so, the expert team behind this innovative atlas has integrated both perspectives to provide all those working in dermatologic healthcare with a complete guide to infectious and parasitic dermatoses in their many forms. More than 600 high-quality images demonstrate the common presentation of a wide range of bacterial, viral, and fungal infections, as well those of parasitic conditions of various kinds. Accompanying these are direct and easily understood descriptions of key features and diagnostic clues, making this new text an essential quick-reference tool for trainees and practicing clinicians alike. The Atlas of Clinical Dermatopathology: Infectious and Parasitic Dermatoses includes: * A straightforward, pattern-based approach to dermatologic diagnosis * Full-color illustrations and clear descriptions for easy reference * Combined clinical and histopathological perspectives * Handy diagnostic tips throughout Featuring all this and more, this invaluable atlas offers a uniquely balanced, clear, and comprehensive guide to what can be a difficult process, and will be of tremendous assistance to students, dermatologists, dermatopathologists, and pathologists everywhere.

Leseprobe

Table of Contents

Cover

Title Page

Copyright Page

Foreword

Acknowledgments

CHAPTER 1: Bacterial Infections

1.1 Staphylococcal and Streptococcal Infections

1.2 Other Bacterial Infections: Corynebacteria

1.3 Rochalimaea/Bartonellae

1.4 Mycobacterial Infections

1.5 Actinomycosis

1.6 Borrelia Infections (Lyme Disease)

1.7 Venereal Diseases

1.8 Rickettsial Infections

1.9 Dermatoses Associated with Bacterial Infections

1.10 Dermatoses Mimicking Bacterial Infections

CHAPTER 2: Fungal Infections

2.1 Superficial Cutaneous Fungal Infections

2.2 Subcutaneous Mycoses

2.3 Systemic Mycoses (Deep Fungal Infections)

2.4 Opportunistic Fungal Infections

CHAPTER 3: Viral Infections

3.1 Herpes Viruses

3.2 Human Papilloma Virus (HPV)

3.3 Viral Exanthema

3.4 Parvovirus Infections and Coxsackievirus Infections

3.5 Polyoma Virus Infections

3.6 Poxviruses

3.7 Other Skin Diseases with Suspected Viral Association

CHAPTER 4: Parasitoses

4.1 Protozoan Diseases

4.2 Arthropod:

Arachnids

CHAPTER 5: Helminthic Infections (Parasitic Worms)

5.1 Larva Migrans (Plumber’s Itch; Creeping Eruption)

5.2 Filariasis

5.3 Onchocerciasis (River Blindness)

5.4 Cysticercosis

5.5 Sparganosis

5.6 Schistosomiasis (Bilharziasis)

5.7 Cercarial Dermatitis (Swimmer’s Itch)

5.8 Annelida (Ringed Worms; Segmented Worms)°

5.9 Hirudinea (Leeches)

CHAPTER 6: Sepsis

6.1 Septic Vasculitis

6.2 Bacterial Sepsis

6.3 Fungal Sepsis

Index

End User License Agreement

List of Tables

Chapter 3

Figure 3.2 Human Papilloma Virus (HPV) Infections.

List of Illustrations

Chapter 1

Figure 1.1.1.1 Impetigo Contagiosa.

Figure 1.1.1.2 Impetigo Contagiosa.

Figure 1.1.2 Ostiofolliculitis (Bockhardt).

Figure 1.1.3 Pseudomonas (Gram‐Negative) Folliculitis (Whirlpool Dermatitis)...

Figure 1.1.4 Perianal Streptococcal Dermatitis.

Figures 1.1.5 and 1.1.6 Differential Diagnosis: Acne Papulopustulosa and Pse...

Figure 1.1.7 Ecthyma Gangrenosum.

Figure 1.1.8 Abscess.

Figure 1.1.9 Furuncle.

Figure 1.1.10 Carbuncle.

Figure 1.1.11.1 Erysipelas (Cellulitis).

Figure 1.1.11.2 Erysipelas (Cellulitis), bullous.

Figure 1.1.12.1 Phlegmon.

Figure 1.1.12.2 Phlegmon, bullous.

Figure 1.1.14 Hidradenitis Suppurativa (Acne Inversa).

Figure 1.2.1 Erythrasma.

Figure 1.2.2 Pitted Keratolysis (Keratoma Sulcatum).

Figure 1.2.3 Trichobacteriosis (Trichomycosis) Palmellina.

Figure 1.2.4 Erysipeloid.

Figure 1.2.5 Anthrax.

Figure 1.2.6 Nocardiosis.

Source:

The images top left and right is modified ...

Figure 1.2.7 Rhinoscleroma.

Figure 1.3.1 Bacillary Angiomatosis and Cat Scratch Disease (top right).

Figure 1.3.2 Verruga Peruana.

Figure 1.3.3 Differential Diagnosis: Pyogenic Granuloma (Lobular Capillary H...

Figure 1.4.1.1 Primary Tuberculosis of the Skin.

Figure 1.4.1.2 BCG Vaccination Granuloma.

Figure 1.4.1.3 Differential Diagnosis: Lupus Miliaris Disseminatus Faciei....

Figure 1.4.1.4 Lupus Vulgaris.

Figure 1.4.1.5 Variant: Tuberculosis (Lupus) Cutis Verrucosa.

Figure 1.4.1.6 Variant: Tuberculosis Cutis Colliquativa (Scrofuloderma).

Figure 1.4.1.7 Lichen Scrofulosorum (Tuberculosis Cutis Lichenoides).

Figure 1.4.1.8 Papulonecrotic Tuberculid.

Figure 1.4.1.9 Erythema Induratum (Bazin).

Figure 1.4.2 Fish Tank (Swimming Pool) Granuloma.

Figure 1.4.3.1 Leprosy, Tuberculoid (Paucibacillary) (TT).

Figure 1.4.3.2.1 Leprosy: Borderline Tuberculoid (BT).

Figure 1.4.3.2.2 Leprosy, Borderline Lepromatous.

Figure 1.4.3.3 Leprosy, Lepromatous (LL).

Figure 1.4.3.4 Leprosy, Histoid Lepromatous (HL).

Figure 1.4.3.5 Virchow cell‐rich variant of ENL with minimal vasculitis.

Figure 1.5 Actinomycosis.

Figure 1.6.1 Variant: Erythema (Chronicum) Migrans (ECM) (Stage I).

Figure 1.6.2.1 Variant: Lymphadenosis Cutis Benigna (Pseudolymphoma; Lymphoc...

Figure 1.6.2.2 Variant: Lymphadenosis Cutis Benigna (Pseudolymphoma; Lymphoc...

Figure 1.6.3 Variant: Morphea/Scleroderma‐Like Lesions (Stage II).

Figure 1.6.4.1 Variant: Acrodermatitis Chronica Atrophicans (Stage III).

Figure 1.6.4.2 Variant: Acrodermatitis Chronica Atrophicans (Stage III).

Figure 1.6.5 Variant: Juxta‐Articular Fibrous Nodules in Acrodermatitis Chro...

Figure 1.7.1 Gonorrhea.

Figure 1.7.2.1 Syphilis (Stage I).

Figure 1.7.2.2 Syphilis, Papular (Stage II).

Figure 1.7.3 Ulcus Molle (Chancroid).

Figure 1.7.4 Granuloma Inguinale (Donovanosis; Granuloma Venereum).

Figure 1.7.5 Lymphogranuloma Inguinale (Lymphogranuloma Venereum; Durand–Nic...

Figure 1.8 Rickettsial Infections.

Figure 1.9.1 Staphylococcal Scalded Skin Syndrome (SSSS).

Figure 1.9.2 Differential Diagnosis: Toxic Epidermal Necrolysis (TEN).

Figure 1.10.1 Pyoderma Gangrenosum.

Figure 1.10.2 Infantile Acropustulosis

Figure 1.10.3 Acute Generalized Exanthematous Pustulosis (AGEP).

Figure 1.10.4 Psoriasis Pustulosa.

Figure 1.10.5 Localized Neutrophilic Eccrine Hidradenitis.

Figure 1.10.6 Erosive Pustular Dermatitis of the Scalp.

Chapter 2

Figure 2.1.1 Variants: Tinea Corporis; Tinea Faciei.

Figure 2.1.2.1 Variant: Tinea Barbae (Trichophytia).

Figure 2.1.2.2 Variant: Tinea Barbae (Trichophytia).

Figure 2.1.3 Granuloma Trichophyticum (Majocchi’s Granuloma).

Figure 2.1.4 Candidiasis (Moniliasis).

Figure 2.1.5 Candida Tropicalis and Candida Lipolytica.

Figure 2.1.6 Pityriasis (Tinea) Versicolor.

Figure 2.1.7 Variant: Malassezia (Pityrosporum) Folliculitis.

Figure 2.1.8 Differential Diagnosis: Seborrheic dermatitis.

Figure 2.1.9 Tinea Nigra.

Figure 2.2.1 Sporotrichosis.

Figure 2.2.2 Mycetoma (Madura Foot).

Figure 2.2.3 Chromo(blasto)mycosis (Verrucous Dermatitis).

Figure 2.3.1.1 Cryptococcosis (Spores with Mucoid Capsule).

Figure 2.3.1.2 Cryptococcosis, Granulomatous (Spores without Mucoid Capsules...

Figure 2.3.2 North American Blastomycosis.

Figure 2.3.3 Lobomycosis (Keloidal Blastomycosis).

Figure 2.3.4 Histoplasmosis.

Figure 2.3.5 Coccidioidomycosis.

Figure 2.3.6 Paracoccidioidomycosis.

Figure 2.3.7 Emmonsiosis.

Figure 2.4.1 Aspergillosis (Alternaria).

Figure 2.4.2 Zygomycosis (Mucormycosis; Phycomycosis).

Figure 2.4.3 Hyalohyphomycosis.

Figure 2.4.4 Phaeohyphomycosis.

Figure 2.4.5 Protothecosis, Cutaneous.

Chapter 3

Figure 3.1.1 Herpes Simplex.

Figure 3.1.2 Varicella/Zoster.

Figure 3.1.2.1 Herpes Simplex; Varicella (Chickenpox)/Zoster (Shingles).

Figure 3.1.2.2.1 Herpes Simplex; Varicella (Chickenpox)/Zoster (Shingles).

Figure 3.1.2.2.2 Varicella (Chickenpox)/Zoster (Shingles).

Figure 3.1.2.3 Special Feature: Necrotizing (Herpes) Zoster Folliculitis.

Figure 3.1.2.4 Special Feature: Zoster‐Associated Vasculitis.

Figure 3.1.3 Burkitt Lymphoma (HHV‐4; Epstein‐Barr Virus; EBV).

Figure 3.1.4 Hairy Leukoplakia (HHV‐4 Epstein‐Barr Virus; EBV).

Figure 3.1.5 Cytomegalovirus (CMV; HHV‐5).

Figure 3.1.6 Exanthema Subitum (HHV‐6) (Roseola Infantum).

Figure 3.1.7.1 Pityriasis Rosea (HHV‐7).

Figure 3.1.7.2 Pityriasis Rosea (HHV‐7).

Figure 3.1.8.1 Kaposi Sarcoma; Patch (Macular) Stage (HHV‐8).

Figure 3.1.8.2 Kaposi Sarcoma; Plaque Stage (HHV‐8).

Figure 3.1.8.3 AIDS‐Kaposi Sarcoma; Tumor Stage (HHV‐8).

Figure 3.1.8.4 Special Feature: AIDS‐Kaposi Sarcoma (HHV‐8), Lymphangioma‐Li...

Figure 3.1.9 Multicentric Castleman’s Disease (HHV‐8).

Figure 3.2.1.1 Verruca Vulgaris.

Figure 3.2.1.2 Verruca Vulgaris.

Figure 3.2.1.3 Variant: Verruca Plantaris.

Figure 3.2.2 Variant: Verrucae Planae.

Figure 3.2.3 Variant: Condylomata Accuminata.

Figure 3.2.4 Differential Diagnosis: Acrokeratosis Verruciformis (Hopf).

Figure 3.2.5 Bowenoid Papulosis.

Figure 3.2.6 Epidermodysplasia Verruciformis (EV) (Lewandowsky–Lutz).

Figure 3.3.1 Measles.

Figure 3.4.1 Erythema Infectiosum; (Slapped Cheek Disease; Fifth Disease).

Figure 3.4.2 Gloves‐and‐Socks Sndrome.

Source:

Courtesy of L. Requena,MD, Ma...

Figure 3.4.3 Hand‐Foot‐and‐Mouth Disease.

Figure 3.5.1.1 Trichodysplasia Spinulosa.

Figure 3.5.1.2 Differential Diagnosis: Follicular Spicules in Myeloma (Nazza...

Figure 3.5.2 Merkel Cell Carcinoma (Primary Neuroendocrine Carcinoma of the ...

Figure 3.6.1.1 Cowpox (Catpox).

Figures 3.6.1.2 and 3.6.1.3 Vaccinia Inoculata; Smallpox (Variola Vera).

Figure 3.6.2.1 Ecthyma Contagiosum (Orf).

Figure 3.6.2.2 Variant: Milker’s Nodule.

Figure 3.6.2.3 Molluscum Contagiosum.

Figure 3.7.1 Asymmetric Periflexural Exanthema of Childhood.

Figure 3.7.2 Eruptive Pseudoangiomatosis.

Figure 3.7.3 Gianotti–Crosti Syndrome.

Figure 3.7.4.1 Pityriasis Lichenoides.

Figure 3.7.4.2 Pityriasis Lichenoides.

Chapter 4

Figure 4.1.1.1 Leishmaniasis.

Figure 4.1.1.2 Leishmaniasis.

Figure 4.1.2 Variant: Leishmaniasis Mexicana.

Figure 4.1.3 Amebiasis: Entamoeba Histolytica.

Figure 4.1.4 Rhinosporidiosis.

Figure 4.2.1.1 Mites: Demodex Folliculorum.

Figure 4.2.1.2 Mites: Scabies.

Figure 4.2.1.3 Variant: Scabies Crustosa.

Figure 4.2.1.4 Trombidiosis (Harvest Mites; Chigger Itch).

Figure 4.2.4 Arthropods: Insects Cimex Lectularius; Bedbugs (left). Pediculo...

Figure 4.2.5 Tungiasis (Sand Flea).

Chapter 5

Figure 5.1 Larva Migrans (Plumber’s Itch; Creeping Eruption).

Figure 5.2 Filariasis.

Figure 5.3 Onchocerciasis.

Figure 5.4 Cysticercosis.

Figure 5.5 Sparganosis.

Figure 5.6 Schistosomiasis (Bilharziasis).

Figure 5.7 Cercarial Dermatitis (Swimmer’s Itch).

Figure 5.9 Hirudinea (Leeches).

Chapter 6

Figure 6.1.1 Septic Vasculitis.

Figure 6.1.2 Septic Vasculitis.

Figure 6.1.3 Septic Vasculitis.

Figure 6.2.1 Variant: Gonococcal Sepsis.

Figure 6.3.1 Variant: Penicillium Marinum Sepsis.

Figure 6.3.2 Variant: Candida Sepsis.

Figure 6.3.3 Variant: Aspergillus Sepsis.

Guide

Cover Page

Atlas of Clinical Dermatopathology

Copyright

Dedication

Foreword

Acknowledgments

Table of Contents

Begin Reading

Index

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Atlas of Clinical Dermatopathology

Infectious and Parasitic Dermatoses

Editor‐in‐Chief

Günter Burg MD

Department of Dermatology

University of Zurich

Zurich

Switzerland

Associate Editors

Heinz Kutzner MD

Department of Dermatology

Institute of Dermatopathology

Friedrichshafen

Germany

Werner Kempf MD

Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland

Department of Dermatology

University of Zurich

Zurich

Switzerland

Josef Feit MD, PhD

Department of Pathology

University of Ostrava

Czech Republic

Omar Sangueza MD

Departments of Pathology and Dermatology

Wake Forest School of Medicine

Winston‐Salem

NC, USA

This edition first published 2021© 2021 John Wiley & Sons Ltd.

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The right of Günter Burg, Heinz Kutzner, Werner Kempf, Josef Feit, and Omar Sangueza to be identified as the author(s) of this work has been asserted in accordance with law.

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Library of Congress Cataloging‐in‐Publication Data

Names: Burg, Günter, author. | Kutzner, Heinz, author. | Kempf, Werner, author. | Feit, Josef, author. | Sangueza, Omar P., author.Title: Atlas of clinical dermatopathology : infectious and parasitic dermatoses / Editor‐in‐chief Günter Burg ; associate editors, Heinz Kutzner, Werner Kempf, Josef Feit, Omar Sangueza.Description: Hoboken, NJ : Wiley‐Blackwell, 2021. | Includes bibliographical references and index.Identifiers: LCCN 2020028076 (print) | LCCN 2020028077 (ebook) | ISBN 9781119647065 (hardback) | ISBN 9781119647089 (adobe pdf) | ISBN 9781119647058 (epub)Subjects: MESH: Skin Diseases, Infectious | AtlasClassification: LCC RL201 (print) | LCC RL201 (ebook) | NLM WR 17 | DDC 616.5/2–dc23LC record available at https://lccn.loc.gov/2020028076LC ebook record available at https://lccn.loc.gov/2020028077

Cover Design: WileyCover Images: © Günter Burg, © Heinz Kutzner, © Werner Kempf

To our families and teachers

Foreword

Atlas of Clinical Dermatopathology

Vol III

Infectious and Parasitic Dermatoses

A myriad of microbes live in us, on us, and around us in a symbiotic or parasitic relationship, fighting with our local cutaneous or systemic defense mechanisms. Without claim of being comprehensive or of following standard biologic taxonomies, this third volume on clinical dermatopathology contains more than 100 infectious and parasitic dermatoses, the clinical features (CFs) and histological features (HFs) of which are described with short concise text and information in bullet‐point style. They are illustrated in over 600 high‐resolution pictures with annotations. A final chapter deals with sepsis.

Since CFs and HFs are nonspecific in many cases, searching for bacterial or fungal pathogens using special stains, microbiologic cultures, or PCR probes may be helpful tools in confirming the diagnosis.

Editor‐in‐ChiefGünter Burg

Associate EditorsHeinz KutznerWerner KempfJosef FeitOmar Sangueza

Acknowledgments

Many of the histological images shown are taken from the Hypertext Atlas of Dermatopathology (https://atlases.muni.cz/) edited by Josef Feit, Hana Jedličková, Günter Burg, Luděk Matyska, Spasoje Radovanovic, Werner Kempf, Leo Schärer et al.) Computational resources for the atlases were provided by the CESNET LM2015042 and CERIT Scientific Cloud LM2015085 large research and development programs.

The chapter on leprosy (Hansen disease) was prepared in cooperation with Ram Chandra Adhikari, MD, Consultant Dermatopathologist, DISHARC Hospital, Kathmandu, Nepal.

For basic information on clinical Dermatology you may refer free of charge to the e‐learning platform DOIT (Dermatology Online with Interactive Technology: https://cyberderm.net/en/home/login.html).

We are grateful to the following colleagues, who kindly have provided clinical or hstological pictures: Luis Requena, MD, Madrid/Spain; Marianne Gloor, MD, Zürich‐Bülach/Switzerland; Regina Fölster‐Holst, MD, Kiel, Germany.

We appreciate the language editing by Angela Niehaus, MD, and Karen Strenge, MD, Wake Forest, North Carolina, United States, and by Aravind Kannankara, United Kingdom the support of the Wiley Publishing Group and its co‐workers, especially by Bhavya Boopathi.

CHAPTER 1Bacterial Infections

CHAPTER MENU

1.1 Staphylococcal and Streptococcal Infections

1.1.1 Impetigo Contagiosa

1.1.2 Ostiofolliculitis (Bockardt)

1.1.3 Pseudomonas (Gram‐Negative) Folliculitis (Whirlpool/Hot Tub Dermatitis)

1.1.4 Perianal Streptococcal Dermatitis

1.1.5 Differential Diagnosis: Acne Papulopustulosa

1.1.6 Differential Diagnosis: Pseudofolliculitis Barbae

1.1.7 Ecthyma Gangrenosum

1.1.8 Abscess

1.1.9 Furuncle

1.1.10 Carbuncle

1.1.11 Erysipelas (Cellulitis)

1.1.12 Phlegmon

1.1.13 Necrotizing Fasciitis (Streptococcal Gangrene)°

1.2 Other Bacterial Infections: Corynebacteria

1.2.1 Erythrasma

1.2.2 Pitted Keratolysis (Keratoma Sulcatum)

1.2.3 Trichobacteriosis (Trichomycosis) Palmellina

1.2.4 Erysipeloid

1.2.5 Anthrax

1.2.6 Nocardiosis

1.2.7 Rhinoscleroma

1.3 Rochalimaea/Bartonellae

1.3.1 Bacillary Angiomatosis and Cat Scratch Disease

1.3.2 Verruga Peruana

1.3.3 Differential Diagnosis: Pyogenic Granuloma (Lobular Capillary Hemangioma; Botryomycosis)

1.4 Mycobacterial Infections

1.4.1 Tuberculosis Cutis

1.4.2 Atypical Mycobacteriosis: Fish Tank (Swimming Pool) Granuloma

1.4.3 Leprosy (Hansen Disease)

1.4.4 Buruli Ulcer

1.5 Actinomycosis

1.6 Borrelia Infections (Lyme Disease

1.6.1 Variant: Erythema (Chronicum) Migrans (ECM) (Stage I)

1.6.2 Variant: Lymphadenosis Cutis Benigna (Pseudolymphoma, Lymphocytoma Cutis) (Stage I)

1.6.3 Variant: Morphea/Scleroderma‐Like Lesions (Stage II)

1.6.4 Variant: Acrodermatitis Chronica Atrophicans (Stage III)

1.6.5 Variant: Juxta‐Articular Fibrous Nodules in Acrodermatitis Chronica Atrophicans (Stage III)

1.6.6 Differential Diagnosis: Actinic Reticuloid°

1.7 Venereal Diseases

1.7.1 Gonorrhea

1.7.2 Syphilis, Chancre

1.7.3 Ulcus Molle (Chancroid)

1.7.4 Granuloma Inguinale (Donovanosis; Granuloma Venereum)

1.7.5 Lymphogranuloma Inguinale (Lymphogranuloma Venereum; Duran‐Nicolas–Favre Disease)

1.8 Rickettsial Infections

1.9 Dermatoses Associated with Bacterial Infections

1.9.1 Staphylococcal Scalded Skin Syndrome (SSSS)

1.9.2 Differential Diagnosis: Toxic Epidermal Necrolysis (TEN)

1.10 Dermatoses Mimicking Bacterial Infections

1.10.1 Pyoderma Gangrenosum

1.10.2 Infantile Acropustulosis

1.10.3 Acute Generalized Exanthematous Pustulosis (AGEP)

1.10.4 Psoriasis Pustulosa

1.10.5 Localized Neutrophilic Eccrine Hidradenitis Associated with Mitoxantrone Treatment

1.10.6 Erosive Pustular Dermatitis (Pustular Ulcerative Dermatosis) of the Scalp

°no pictures

1.1 Staphylococcal and Streptococcal Infections

1.1.1 Impetigo Contagiosa

Figure 1.1.1.1 Impetigo Contagiosa.

Figure 1.1.1.2 Impetigo Contagiosa.

CF: Streptococcal infections initially induce erythematous patches with fragile subcorneal tiny vesicles, which easily rupture and develop into yellowish crusts.

Bullous lesions with thicker blister roof are usually due to staphylococcal infection.

The face and extremities of children are the most common localizations.

Impetiginization of various inflammatory skin disorders is caused by secondary infection.

HF:

Subcorneal vesicles filled with neutrophils

Acantholytic changes in the granular layer

The thin roof of the pustule is often detached and replaced by necrotic crusty debris

Neutrophil‐rich lymphohistiocytic infiltrate in the upper dermis

DD: Pemphigus foliaceus (similar histology, no bacteria, positive direct immuno‐fluorescence).

Reference

Darmstadt, G. L., & Lane, A. T. (1994). Impetigo: An overview.

Pediatr Dermatol

,

11

(4), 293–303.

Durdu, M., Baba, M., & Seckin, D. (2008). The value of Tzanck smear test in diagnosis of erosive, vesicular, bullous, and pustular skin lesions.

J Am Acad Dermatol

,

59

(6), 958–964.

1.1.2 Ostiofolliculitis (Bockardt)

Figure 1.1.2 Ostiofolliculitis (Bockhardt).

Folliculitis is a general term, describing inflammatory reactions within and around follicular structures. There are many types of folliculitis, including infectious, inflammatory, mechanical, or chemical ones. In infectious folliculitis bacterial, fungal or viral agents can be involved, mostly in conjunction with predisposing factors like diabetes, atopic dermatitis, or immunodeficiencies.

Staphylococcus aureus, Streptococcus pyogenes, and Pseudomonas aeruginosa most commonly affect follicular structures, leading to acute superficial folliculitis, with or without deep abscess formation or chronic granulomatous inflammation. Bacterial and fungal folliculitis show similar microscopic features.

CF: Small yellow, dome‐shaped pustules in a follicular distribution with the terminal or vellus hair in the center. Preferential localizations are scalp, face, and axillae.

HF: Bacterial and fungal folliculitis show similar microscopic features. Neutrophils are present in the upper part of the follicle, the infundibulum, or the subcorneal layer of the epidermis.

DD: Other forms of infectious, mechanical, or chemical folliculitis.

1.1.3 Pseudomonas (Gram‐Negative) Folliculitis (Whirlpool/Hot Tub Dermatitis)

Figure 1.1.3 Pseudomonas (Gram‐Negative) Folliculitis (Whirlpool Dermatitis).

Pseudomonas aeruginosa is a gram‐negative bacterium which is part of the normal flora of the large skin folds and intertriginous areas. Under special local predisposing conditions or in patients with diabetes or patients under immunosuppression, “whirlpool” or hot tub folliculitis may develop.

CF: Disseminated painful pustules, mostly at body sites covered by bathing suit.

HF:

Follicles, with follicle walls partly ruptured

Acneiform intra‐ and perifollicular inflammatory infiltrate, predominantly neutrophilic

Plasma cells and eosinophils may be present

DD: Acne; other bacterial, fungal (pityrosporum) or viral (HIV‐associated) folliculitis; demodex folliculitis.

Reference

Mazza, J., Borkin, M., Buchholz, R., & Deleo, V. (2013). Pseudomonas folliculitis contracted from rubber gloves: A public health concern.

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Yu, Y., Cheng, A. S., Wang, L., Dunne, W. M., & Bayliss, S. J. (2007). Hot tub folliculitis or hot hand‐foot syndrome caused by Pseudomonas aeruginosa.

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(4), 596–600.

1.1.4 Perianal Streptococcal Dermatitis

Figure 1.1.4 Perianal Streptococcal Dermatitis.

This is caused by group B β‐hemolytic streptococci. Similar symptoms may more frequently be caused by perianal allergic, toxic, seborrheic, or atopic dermatitis.

CF: Circumscribed pruritic eczematous erythema in the gluteal and perianal region, mostly by bacterial dissemination from the upper respiratory tract, most commonly in young children but also in adults.

HF: Variable nonspecific histologic features. Diagnosis depends on positive swab for β‐hemolytic streptococci. The rationale for taking a biopsy may lie in the exclusion of other conditions (differential diagnoses; see below).

DD: Erysipelas; fungal infection; contact dermatitis; psoriasis; Langerhans cell histiocytosis; zinc deficiency/acrodermatitis enteropathica; intertrigo; lichen planus.

Reference

Kahlke, V., Jongen, J., Peleikis, H. G., & Herbst, R. A. (2013). Perianal streptococcal dermatitis in adults: Its association with pruritic anorectal diseases is mainly caused by group B Streptococci.

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(5), 602–607.

Serban, E. D. (2018). Perianal infectious dermatitis: An underdiagnosed, unremitting and stubborn condition.

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(4), 89–104.

1.1.5 Differential Diagnosis: Acne Papulopustulosa

Figures 1.1.5 and 1.1.6 Differential Diagnosis: Acne Papulopustulosa and Pseudofolliculitis Barbae.

CF: Papulopustular lesions, preferentially in the face during puberty and in adolescence. Various grades of severity: acne comedonica (I); acne papulopustulosa (II); acne conglobata (III).

HF (acne papulopustulosa):

Ruptured hair follicle

Hyperparakeratosis in the ostium and infundibular parts of the hair follicles with keratin and cellular debris

Microorganisms (

Propionibacterium acnes

and

Staphylococcus epidermidis

) surrounded by infiltration with neutrophils

Foreign body (granulomatous) reaction

Reference

Leyden, J. J. (1995). New understandings of the pathogenesis of acne.

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32

(5 Pt 3), S15–25.

1.1.6 Differential Diagnosis: Pseudofolliculitis Barbae

CF: Preferentially in black people with curly hair, recurrent papular and pustular, acneiform lesions occur in the beard area, secondary to razor shaving, and in the neck, where acne keloidalis nuchae is a frequent sequela.

HF:

Fragments of hair, penetrating into the skin

Perifollicular and follicular inflammatory infiltrate

Foreign body reaction with multinucleated giant cells

Fibrosis

Reference