AUTHOR AND EDITOR INFORMATION

Section 1 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

INTRODUCTION

Section 2 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

Background

Disseminate and recurrent infundibular folliculitis (DRIF) was first described in 1968 by Hitch and Lund. The clinical presentation is much like miliaria or keratosis pilaris. It is mostly seen in young healthy people, and most patients have a dark skin color. It consists of generalized flesh-colored papules. Therapy has generally been unsuccessful.

The validity of DRIF as a separate entity has been questioned. However, it does have such a characteristic clinical picture that for the present it is accepted as an entity.

Pathophysiology

The etiology is not established.

Frequency

United States

Although the first case was not reported until 1968, other more recent reports indicate that it is a fairly common occurrence. Clinics that see a large number of young dark-skinned patients report that this is a common condition. Indeed, it may occur in large numbers in hot, humid weather.

International

Cases have been reported from Europe and India.

Mortality/Morbidity

Pruritus is the troublesome symptom. In the past, this was difficult to relieve. The condition may be recurrent over a number of years. The condition may make it uncomfortable for the patient to work in a hot, humid environment.

Race

The condition has been reported primarily in people of African American origin in the United States. Why a number of dermatoses tend to be papular and follicular in dark-skinned people is not known. This phenomenon is well documented in atopic dermatitis.

Sex

Although most of the patients are men, it has been reported in women.

Age

Most of the reported patients have been healthy young adults.

CLINICAL

Section 3 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

History

• Most patients report a sudden onset of a widespread pruritic papular eruption.
• It has been reported to be exacerbated by hot showers and relieved by anything that cools (eg, cool showers, lotions, swimming).
• Occasionally, a patient may report that a number of peers have been affected at the same time.
• Often, a personal or family history of atopy is present.

Physical

• Physical examination reveals a papular eruption that has a follicular location.
• In a given area, all the follicles are involved, with no skipping of any follicles in the area involved.
• The usual sites are the chest and mantle and the upper arms.
• Infundibular folliculitis is rather monomorphic without noted rubor, calor, and dolor.

Causes

• The exact cause is unknown.
• The history often suggests a hot, humid environment as a precipitating cause.
• Once established, the condition tends to persist or recur over a prolonged period.

DIFFERENTIALS

Section 4 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

Other Problems to be Considered

Miliaria rubra pilaris
Papular contact dermatitis notably to homomenthyl salicylate found in sunscreens
Phrynoderma
Various folliculitises, including the one associated with AIDS
Vitamin A deficiency
Juxtaclavicular beaded lines
Apocrine miliaria
Patchy pityriasiform lichenoid eczema (Kitamura-Takahashi-Sasagawa disease)

WORKUP

Section 5 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

Lab Studies

• Patch testing or a potassium hydroxide wet mount may be performed to investigate possible allergic contact dermatitis or Pityrosporum folliculitis.

Procedures

• A biopsy is not diagnostic.

Histologic Findings

Histologic examination reveals superficial spongiotic dermatitis associated with a hair follicle and the adjacent epidermis superficially; this finding is not specific. Exocytosis is noted into the spongiotic area. The subadjacent dermis has inflammatory cells, and the deeper dermis is uninvolved.

TREATMENT

Section 6 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

Medical Care

• Cooling, soothing emollients have been used for 30 years, with variable success.
• Corticosteroids have not been demonstrated to be effective.
• In 1999, Ruvikumar et al reported that psoralen plus ultraviolet light A (PUVA) therapy was successful.
• In 1998 and again in 2004, Aroni et al reported successful treatment with isotretinoin.

Consultations

Although unfamiliar to generalists, dermatologists should recognize this condition.

Activity

Limiting activity under hot, moist conditions may be necessary to prevent or relieve symptoms.

MEDICATION

Section 7 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

Emollients have been used for decades, with variable success. Early reports indicated treatment with vitamin A. Later, vitamin A therapy was reported to be ineffective. Recently, several authors have reported success with isotretinoin systemic therapy. However, the standard dosing protocol has not been established.

FOLLOW-UP

Section 8 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

Further Inpatient Care

• Keeping a patient in a cool, dry environment has been successful in relieving symptoms.

Deterrence/Prevention

• Prevention may be obtained by avoiding exercise in warm, humid environments.

Complications

• Complications can be due to excoriations and possible impetiginous infection.

Prognosis

• The condition may last for years.

MULTIMEDIA

Section 9 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

Media file 1:  Courtesy of San Antonio Uniformed Services Health Education Consortium slide files.
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Media file 2:  Courtesy of San Antonio Uniformed Services Health Education Consortium slide files.
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Media file 3:  Courtesy of San Antonio Uniformed Services Health Education Consortium slide files.
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Media file 4:  Courtesy of San Antonio Uniformed Services Health Education Consortium slide files.
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Media file 5:  Courtesy of San Antonio Uniformed Services Health Education Consortium slide files.
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REFERENCES

Section 10 of 10

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

• Aroni K, Grapsa A, Agapitos E. Disseminate and recurrent infundibulofolliculitis: response to isotretinoin. J Drugs Dermatol. Jul-Aug 2004;3(4):434-5. [Medline].
• Barriere H, Litoux P, Bureau B, Stalder JF. [Disseminate and recurrent infundibulo-folliculitis (Hitch and Lund)]. Ann Dermatol Venereol. Apr 1980;107(4):299-302. [Medline].
• El Shabrawi-Caelen L, Soyer HP. Clinical Pathologic Challenge: Patchy pityriasiform lichenoid eczema. Am J Dermatopathol. Jun 2005;27(3):216, 258.
• Hitch JM, Lund HZ. Disseminate and recurrent infundibulo-folliculitis: report of a case. Arch Dermatol. Apr 1968;97(4):432-5. [Medline].
• Owen WR, Wood C. Disseminate and recurrent infundibulofolliculitis. Arch Dermatol. Feb 1979;115(2):174-5. [Medline].
• Ravikumar BC, Balachandran C, Shenoi SD, et al. Disseminate and recurrent infundibulofolliculitis: response to psoralen plus UVA therapy. Int J Dermatol. Jan 1999;38(1):75-6. [Medline].
• White SW, Rodman OG. Disseminate and recurrent infundibulofolliculitis. J Assoc Military Dermatol. 1981;VII, No 2 [fall]:22-23.

Article Last Updated: Jan 12, 2007