Lionel Bercovitch MD, Clinical Professor of Dermatology, Alpert Medical School, Brown University, Providence, RI, USA, on February 11, 2009
Was the biopsy sample adequate to rule out pancreatic fat necrosis? Is this clinically a panniculitis or is it thought to be a neutrophilic dermatosis?
Parveen Kumar MD, Assistant Prof,
Dasmesh Institute of Research and Dental Sciences,
Faridkot, India, on Febrauary 11, 2009
This case needs HIV test since it seems to be a case of HIV
+ve case.
Bhushan Kumar MD, Consultant Dermatologist, Chandigarh,
India on Feb 12, 2009
Dissecting cellulitis of the scalp is the only likely possibility.
Kerion is least likely. Any chronic inflammation like the nodulocystic
acne triad can have symptoms pertaining to bones and joints.
Non specific plaques with neutrophilic infiltrate are also likely
in chronic inflammation. A course of oral isotretinoin (40mg/day)
combined with doxycycline (100mg/day) given over a period of
4 weeks will be a good therapeutic trial. If response is good
then the treatment has to be continued for 4-6 months.
Richard Sontheimer MD, Professor, Dept. of Dermatology
University of Oklahoma Health Sciences Center, Oklahama City,OK,
USA on Feb 12, 2007
Presumably this pt was not treated with isotretinon (Accutane)
for his dissecting cellulitis resulting in hypertriglyceridemia
that caused pancreatitis and pancreatic panniculitis. If not,
the cause of his pancreatitis should be further addressed and
he should have a full thickness excisional biopsy of an area
on the extremities displaying the subcutaneous inflammation
to better address broad differential diagnosis of panniculitis.
Haitham Al-Qari MD, Assistant Prof, Arabian Gulf University,
Bahrain on Feb 12, 2009
A case of Perifolliculitis capitis abscedens et suffodiens
is a therapeutically challenging suppurative scalp disease of
unknown etiology. I have good success with these options:
1. Oral isotretinoin (1.5 mg/kg/day (usually 1 mg/kg/d) PO)
may be considered the treatment of choice.
2. Intralesional corticosteroids (eg, triamcinolone acetonide
at 5 mg/mL) can be injected into boggy nodules and sinus tracts.
3. Oral zinc sulfate at 400 mg tid and 135 mg tid for 3 months
can help too.
Nidal Obaidat M.D. Dermatologist/Dermatopathologist,
King Hussein Medical Center, Jordan on Feb 12, 2009
I believe a few histology slides are needed to help reach a
diagnosis, esp there is no comment about the subcutis. Also,
I think imaging studies of the abdomen (pancreas) are due.
Fadi Hajjaj MD, Dermatology, UK on February 15, 2009
The diagnosis is Perifolliculitis capitis abscedens et suffodiens based on clinical picture. My own approach as follows:
1- Systemic antibiotics treatment (Minocycline 100mg once daily for 3-4 months)
2- regular Intralesional steroids for cystic lesions (i found it very effective and improves the patient quality of life).
3- Isotretinoin is worth trying as possible option , but i dont expect excellant results in Perifolliculitis capitis.
Nico Mousdicas MD, USA on March 3, 2009
This clinically is dissecting cellulitis of the scalp. I consider this condition similar to Pyoderma Fulminans a form of Rosacea. This comes on in patients very acutely due to severe stress.
I treat them with Rifampicin 300mg daily, Clindamycin 300mg bid for 1 to 3 months. I also prescribe Prednisone 40 mg daily for 2 weeks with no taper and re-assess them at this time. The condition literally melts away. I also look to try and find out what has caused the distress and treat appropriately with counselling and SSRI's
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