Scalp traction follicurlitis : Unreported entity in Iraqi female children

Abstract

Background. Folliculitis is inflammation of hair follicle caused by infection, chemical irritation or physical injury. Case series of scalp folliculitis in Iraqi female children (unreported previously) were identified; all patients had a history of mechanical traction. Objectives. To evaluate and charac- terize a new entity of scalp “Traction Folliculitis” apart from well known Traction Alopecia. Patients and Methods. A series of 45 patients with clinically diagnosed scalp folliculitis were observed to have “Traction Folliculitis” during the period from October 2008 and October 2011 in private practice using an observational study. History was obtained about age, residence, gender, previous similar lesions, type of hair style, coloring agents and associated signs and symptoms. Results. A total of 45 patients with clinically diagnosed scalp folliculitis were observed to have “Traction Folliculitis” of scalp, con- sisting of fine scalp scales, perifollicular erythema and pustules, associated with prominent hair casts. The presenting symptoms were pain (especially during cleaning and combing the hair), itching . There were lymphadenopathy in 7 patients (15.6%). No other similar skin lesions in nearby area in the neck or face, no nits of pediculosis capitis, no fragile crustation of impetigo. The disease from the first im- pression looks as if scalp pediculosis (pediculosis capitis), but there are no nits. Surprisingly the pa- tients were all females with an age group between (1.5-11 year) (4.82+ 2.42). The color of hair was brown in 38 patients (84.5%), black in 6 patients (13.3%) and only one blond girl (2.2%). Types of hair styles were ponytails (horsetail) with hair-cutters in 28 patients (62.2%), 2 lateral braids in 16 pa- tients (35.6%) and one patient (2.2%) with 5 posterior braids. All patients were giving history of sus- tained severe hair traction. No curly hair, no black patients were observed. One patient (2.2%) men- tioned using hair dye (Henna dye) as a coloring agent. This issue was solved and managed by chang- ing the hairstyle, undo the traction, using mild antiseptic soaps and non irritant shampoos, some re- quired systemic antibiotics for one week. It is unreported before as a separate entity as Traction Fo- liculitis and could easily passed or categorized as pediculosis capitis due to the similarity of hair casts with nits. The age group was mainly preschool age 33 patients (73.3%) and few primary school ages 12 patients (26.7%).