10.5826/dpc.1202a55
text/xml
2160-9381
1780
en
Pavithra Ayyanar
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
papilloma
Dermoscopy of viral folliculitis of the beard: report of two cases
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-05-02
2021-05-07
2022-05-02
2022-05-24
e2022055
Dermatol Pract Concept
Pavithra Ayyanar
2022/05/02
10.5826/dpc.1202a55
e2022055
Department of Pathology, AIIMS, Bhubaneswar, India
2160-9381
papilloma
en
e2022055
Durdu M, Errichetti E, Eskiocak AH, Ilkit M. High accuracy of recognition of common forms of folliculitis by dermoscopy: An observational study. J Am Acad Dermatol. 2019;81(2):463-471. DOI: 10.1016/j.jaad.2019.03.054. PMID: 30914342.
Dermoscopy of viral folliculitis of the beard: report of two cases
https://dpcj.org/index.php/dpc/article/download/1780/1561
         Dermoscopy of Viral Folliculitis of the Beard:
                   Report of Two Cases
             Biswanath Behera1, Rashmi Kumari2, Debasis Gochhait3, Pavithra Ayyanar4


1 Department of Dermatology, and Venereology, AIIMS, Bhubaneswar, India
2 Department of Dermatology, Venereology and Leprology, JIPMER, Puducherry, India
3 Department of Pathology, JIPMER, Puducherry, India
4 Department of Pathology, AIIMS, Bhubaneswar, India



Key words: dermoscopy, folliculitis, molluscum contagiosum, papilloma
Citation: Behera B, Kumari R, Gochhait D, Ayyanar P. Dermoscopy of viral folliculitis of the beard: report of two cases.
Dermatol Pract Concept. 2022;12(2):e2022055. DOI: https://doi.org/10.5826/dpc.1202a55
Accepted: September 1, 2021; Published: April 2022
Copyright: ©2022 Behera et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication
Corresponding author: Rashmi Kumari, M.D., Associate Professor, Dept. of Dermatology, Venereology and Leprology, JIPMER,
Puducherry, India Pin-605006. E-mail: rashmi.sreerag@gmail.com




Introduction                                                            papule showed lobular epidermal acanthosis with prominent
                                                                        intracytoplasmic Henderson-Patterson bodies, consistent
Differentiating human papillomavirus (HPV) folliculitis                 with a diagnosis of MC folliculitis (Figure 1C).
from molluscum contagiosum (MC) folliculitis over the                        The second case is A 33-year-old male who had multi-
beard area can be clinically challenging. Both can present              ple asymptomatic skin lesions over the beard for the last 6
as asymptomatic follicle-based papules, and the verrucous               months. He denied any history of recent cosmetic procedures.
morphology of HPV infection and punctum of MC may not                   ­Cutaneous examination revealed multiple ­follicle-based skin-­
be appreciable in all cases.                                            colored flat-topped (2 mm X 3 mm) papules (Figure 2A).
                                                                        Dermoscopy showed a perifollicular mosaic pattern compris-
                                                                        ing a variable-shaped white knob-like area with or without
Case presentation
                                                                        central dotted and hairpin vessels (Figure 2B). Histology of
The first case is a 26-year-old male who presented with a               a papule showed basket weave hyperkeratosis, hypergranu-
history of multiple asymptomatic lesions on the beard for               losis, moderate acanthosis, and koilocytes in upper stratum
4 months.. Cutaneous examination showed multiple folli-                 spinosum and granulosum, consistent with the diagnosis of
cle-based skin-colored to pearly-white papules (Figure 1A).             verruca plana/HPV folliculitis (Figure 2C).
Dermoscopic examination under nonpolarized mode showed                       In both the patients, all the investigations, including HIV 1
perifollicular pearly white clods (Figure 1B). Histology of a           and 2 serology, to rule out immunosuppression were negative.




Research Letter | Dermatol Pract Concept. 2022;12(2):e2022055                                                                           1
    Figure 1. (A) Multiple follicle-based skin-colored to pearly-white (arrow) papules. (B) Dermoscopic examination (Heine Delta20®, 10X
    magnification) showing perifollicular pearly white clods. (C) Histology shows endophytic epithelial hyperplasia containing molluscum
    bodies (H & E, X50).




    Figure 2. (A) Multiple follicle-based skin-colored verrucous flat-topped papules. (B) Dermoscopy (Heine Delta20®, 10X magnification)
    shows a perifollicular mosaic pattern comprising of a variable-shaped white knob-like area with or without central dotted and hairpin
    vessels. (C) Histology shows basket weave hyperkeratosis, hypergranulosis, moderate acanthosis, and koilocytes in upper stratum spino-
    sum and granulosum (H & E, X50). Inset showing koilocytes (H & E, X400).




Conclusions                                                                  Verruca vulgaris demonstrates grouped papillae with
                                                                         dotted and hairpin vessels surrounded by a whitish halo.
MC folliculitis is rare and usually occurs in patients with              In contrast, the verruca plana can have dotted vessels on
either acquired or iatrogenic immunosuppression. The pres-               a yellowish background [1]. We observed a mosaic pattern
ence of flesh-colored to erythematous papules with or with-              comprising a white knob-like area with or without a central
out central umbilication is the common presentation.                     hairpin or dotted vessel in the HPV folliculitis.
      HPV can spread from infected materials during cos-                     The dermoscopic features described for other infectious
metic procedures, resulting in cosmetic warts. It can also               folliculitis are the following: dotted vessels in Malassezia
spread along the line of the trauma due to pseudo-Koebner-               folliculitis; broken hairs, corkscrew hairs, black dots, zigzag
ization of preexisting warts [2]. The case in the discussion             hairs, and morse code hairs in dermatophytic folliculitis;
was unique. Each of the flat-topped papules over the beard               central round pustule with peripheral sparse dotted vessels in
area was follicle-based compared to the clustered or linear              staphylococcal folliculitis; and Demodex tails, and Demodex
arrangement described for cosmetic warts or pseudo-Koeb-                 follicular openings in Demodex folliculitis. Another com-
nerization, respectively.                                                mon mimicker, pseudo-olliculitis, demonstrates a U-shaped
      Under dermoscope, MC characteristically demonstrates               in-growing hair under a dermoscope [1,2].
a variable-shaped white clod and crown vessels with or with-                 In conclusion, we report dermoscopic features of 2 rare
out a central punctum. Other features described are rosette,             cases of viral folliculitis on the beard. The dermoscopic ex-
dotted and radial vessels [1,2].                                         amination can help differentiate between MC folliculitis



2                                                                            Research Letter | Dermatol Pract Concept. 2022;12(2):e2022055
from HPV folliculitis, with the former characterized by             2. Durdu M, Errichetti E, Eskiocak AH, Ilkit M. High accuracy of
white clod and the latter by a mosaic pattern.                         recognition of common forms of folliculitis by dermoscopy: An
                                                                       observational study. J Am Acad Dermatol. 2019;81(2):463-471.
                                                                       DOI: 10.1016/j.jaad.2019.03.054. PMID: 30914342.
References
 1. Piccolo V. Update on Dermoscopy and Infectious Skin Diseases.
    Dermatol Pract Concept. 2019;10(1):e2020003. DOI: 10.5826/
    dpc.1001a03. PMID: 31921490. PMCID: PMC6936624.




Research Letter | Dermatol Pract Concept. 2022;12(2):e2022055                                                                     3
