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World J Clin Cases. Dec 16, 2014; 2(12): 815-821
Published online Dec 16, 2014. doi: 10.12998/wjcc.v2.i12.815
Follicular contact dermatitis revisited: A review emphasizing neomycin-associated follicular contact dermatitis
Philip R Cohen
Philip R Cohen, Division of Dermatology, University of California San Diego, San Diego, CA 92131-3643, United States
Author contributions: Cohen PR solely contributed to this paper.
Correspondence to: Philip R Cohen, MD, Division of Dermatology, University of California San Diego, 10991 Twinleaf Court, San Diego, CA 92131-3643, United States. mitehead@gmail.com
Telephone: +1-858-6578322
Received: June 9, 2014
Revised: September 19, 2014
Accepted: September 23, 2014
Published online: December 16, 2014
Processing time: 192 Days and 13.8 Hours
Abstract

Follicular contact dermatitis clinically presents as individual papules that include a central hair follicle. Pathologic features involve the follicle and the surrounding dermis: spongiosis and vesicle formation of the follicular epithelium associated with perifollicular and perivascular lymphocytic inflammation. Using the PubMed database, an extensive literature search was performed on follicular contact dermatitis and neomycin. Relevant papers were reviewed and the clinical and pathologic features, the associated chemicals (including a more detailed description of neomycin), the hypothesized pathogenesis, and the management of follicular contact dermatitis were described. Several agents-either as allergens or irritants-have been reported to elicit follicular contact dermatitis. Several hypotheses have been suggested for the selective involvement of the follicles in follicular contact dermatitis: patient allergenicity, characteristics of the agent, vehicle containing the agent, application of the agent, and external factors. The differential diagnosis of follicular contact dermatitis includes not only recurrent infundibulofolliculitis, but also drug eruption, mite infestation, viral infection, and dermatoses that affect hair follicles. The primary therapeutic intervention for follicular contact dermatitis is withdrawal of the causative agent; treatment with a topical corticosteroid preparation may also promote resolution of the dermatitis. In conclusion, follicular contact dermatitis may be secondary to allergens or irritants; topical antibiotics, including neomycin, may cause this condition. Several factors may account for the selective involvement of the hair follicle in this condition. Treatment of the dermatitis requires withdrawal of the associated topical agent; in addition, topical corticosteroids may be helpful to promote resolution of lesions.

Keywords: Allergic; Contact; Dermatitis; Follicular; Irritant; Neomycin; Papular

Core tip: Follicular contact dermatitis an be elicited by several agents and clinically presents as individual papules that include a central hair follicle. Pathologic features involve the follicle and the surrounding dermis. Hypotheses for the selective involvement of the follicles include patient allergenicity, characteristics of the agent, vehicle containing the agent, application of the agent, and external factors. The differential diagnosis includes dermatoses that affect hair follicles, drug eruption, infundibulofolliculitis, mite infestation and viral infection. Treatment with a topical corticosteroid preparation and/or withdrawal of the causative agent are therapeutic interventions for follicular contact dermatitis.