Follicular Occlusion Syndrome: A Case Report

Abstract

Background: Follicular occlusion syndrome encompasses hidradenitis suppurativa, acne conglobata and dissecting cellulitis of the scalp. These disorders share features of follicular obstruction and inflammation, although their molecular associations remain incompletely understood. Objective: To describe the clinical presentation and management of a patient with the follicular occlusion triad and to discuss possible shared genetic susceptibility without inferring a confirmed molecular diagnosis. Case Presentation: A 60-year-old man had a history of nodulocystic acne since adolescence, recurrent axillary hidradenitis suppurativa and scalp folliculitis. His daughter reportedly had nodulocystic acne. Examination showed comedones, papules, pustules, nodules and cysts on the chest, deep axillary fistulous tracts with hypertrophic scarring, and alopecic scalp plaques with atrophy and fibrosis. Dermatoscopy and trichoscopy documented inflammatory and follicular changes. Axillary biopsy demonstrated hyperkeratosis, a mixed inflammatory infiltrate, fistulous tracts and dermal fibrosis, supporting the clinical diagnosis. Treatment comprised topical clindamycin with benzoyl peroxide and oral doxycycline for four weeks, followed by isotretinoin at 40 mg daily. Partial clinical improvement was observed after eight weeks of isotretinoin. Conclusion: The case illustrates coexisting manifestations of the follicular occlusion spectrum and a family history of severe acne. These observations are compatible with, but do not establish, a shared susceptibility involving Notch signalling and γ-secretase. Molecular genetic testing was unavailable, and longer-term outcomes remain undetermined.