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Disseminate and recurrent infundibulofolliculitis

Author: Dr Ben Tallon, Dermatology Registrar, Greenlane Hospital, Auckland. Reviewed by Clare Morrison, Copy Editor, April 2014.

What is disseminate and recurrent infundibulofolliculitis?

Disseminate and recurrent infundibulofolliculitis (DRIF) is a rare itchy follicular skin condition of unknown cause that occurs mainly in people of African descent.

It is also known as "Hitch and Lund disease" after the pair who first described this condition in 1968.

What does disseminate and recurrent infundibulofolliculitis look like?

Disseminate and recurrent infundibulofolliculitis typically presents as a widespread, mildly itchy, follicular rash (arising within the hair follicle). It has been described as "goose bumps through a magnifying glass". The rash is slightly pink in appearance, often with a brown, pigmented edge. The torso, neck and arms are most affected.

It is mainly found in young healthy people with dark skin colour and is more common in hot, humid climates.

What are the histologic findings of disseminate and recurrent infundibulofolliculitis?

A skin biopsy may be taken to help in diagnosis. There is oedema (swelling) and lymphocytic infiltration (inflammation) around the infundibulum and basal region of the hair follicle. There is widening and proliferation of cells in the upper part of the follicle with variable amounts of scale formation. The skin biopsy direct immunofluorescence test is negative, ie antibodies cannot be detected around the hair follicle.

What is the treatment for disseminate and recurrent infundibulofolliculitis?

There is little response to topical, intralesional or systemic steroids; antibiotics such as doxycycline; or antihistamines.

There are reports of improvement with oral vitamin-A, isotretinoin, and PUVA. Some patients may find relief with cooling and soothing emollients.

What is the prognosis?

Other than its appearance and in some, the itch, there are no serious consequences of this rash. Despite the name, not everyone has recurrent episodes, as a persistent rash is more usual. It generally resolves by itself after some years.

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