Disseminate and Recurrent Infundibulofolliculitis: An Under-Recognized Yet Treatable Entity
December 2021 | Volume 20 | Issue 12 | Features | 1353 | Copyright © December 2021
Published online November 30, 2021
Betty C. Ma BA,a Vikram Nath Sahni BS,b Dev Ram Sahni MD MHA,c Aaron M. Secrest MD PhDc
aSchool of Medicine, Virginia Commonwealth University, Richmond, VA
bCollege of Medicine, Drexel University, Philadelphia, PA
cDepartment of Dermatology, University of Utah Health, Salt Lake City, UT
Disseminate and recurrent infundibulofolliculitis (DRIF) is a pruritic papular eruption that predominantly affects young adults with Fitzpatrick skin types 4-6. Due to DRIF’s rarity and under-recognition, no standardized treatment guidelines exist. However, several oral agents have been used, including vitamin A, antibiotics, and retinoids. Topical agents, such as calcineurin inhibitors and mid-potency steroids, can also be efficacious. This brief communication summarizes treatments for DRIF in the published literature. J Drugs Dermatol
. 2021;20(12):1353-1354. doi:10.36849/JDD.6173
Disseminate and recurrent infundibulofolliculitis (DRIF) is a rare skin condition of unknown etiology first reported by Hitch and Lund in 1968.1 In our clinical practice, we have encountered this condition infrequently, but it poses a significant therapeutic challenge. Characterized by skin-colored follicular papules on the trunk and proximal extremities, DRIF is more prevalent among young men of African descent and those with Fitzpatrick skin types 4-6.1 The papules are pruritic and can demonstrate trichosis and become pustular.1,5 DRIF is often self-limiting; however, the pruritic component can be bothersome.
The etiology of the condition is not known, and it is often misdiagnosed or underrecognized as a clinical entity. However, the pathophysiology is similar to other folliculitis disorders with an inflammatory infiltrate affecting the infundibulum.1,2 As a consensus is lacking on standardized treatment of DRIF, clinician preference often drives treatment. The aim of this brief communication is to summarize effective treatments for DRIF.
A search was conducted using the PubMed database.
The following keywords were searched in batch phrases:
disseminate, recurrent, infundibulofolliculitis, and treatment.
A variety of treatments have been used and have demonstrated
success at alleviating DRIF symptoms (Table 1).1-10
Treatment of DRIF remains widely anecdotal. Oral vitamin A and isotretinoin can be efficacious due to their promotion of decreased follicular turnover and slower keratinization.2,6,8 A combination of oral vitamins A and E appears to have beneficial outcomes as well. However, oral retinoids are often limited by their systemic side effects and resultant laboratory abnormalities. Although topical retinoids have not been trialed in literature, we contend that they would likely also be beneficial given similar mechanisms of action.
Alternative treatments with smaller sample sizes include light therapy, topical steroids, and topical calcineurin inhibitors. Narrow-band ultraviolet B therapy and methoxypsoralen plus ultraviolet A therapy(PUVA) promote altered cytokine expression, which can result in apoptosis and increased immunosuppression of Langerhans cells. Both topical steroids and calcineurin-based inhibition promote decreased inflammation and irritation. Antibiotics with added anti-inflammatory properties can reduce DRIF-associated infundibular swelling.1,9,10
With only a handful of DRIF cases documented, knowledge regarding disease maintenance and time course for treatment is limited. However, improvement typically occurs within 4 to 8 weeks. Relapse can occur, and it is unclear based on existing literature if repeat treatment with the same modality or adjunct therapy is necessary.
Ultimately, DRIF remains an uncommon and underdiagnosed