Follicular contact dermatitis revisited: A review emphasizing neomycin-associated follicular contact dermatitis

Table 1 Agents associated with allergic follicular contact dermatitis

Agent	Comment	Ref.
Ammonium fluoride	A farm helper who sprayed trees with chemical and had an exudative dermatitis and a postal employee with right foot and bilateral popliteal dermatitis; patch test showed folliculoporal reaction	[2]
Chromium trioxide	A shoe-shiner with severe hand dermatitis, a plasterer who worked with cement (after a cast had been applied to his hand to treat a fracture), and an electrician with chronic dermatitis flared when he drilled through aluminum coated with zinc chromate primer; all had a folliculoporal patch testing reaction	[2]
Cobalt chloride	103 follicular patch test reactions in 853 heavy metal workers that were tested	[3]
Colored permanent pressing sheets chemical	Sheets were 50% cotton and 50% polyester; widely dissmeniated erythematous follicular keratotic papules; primarily on hairy areas with a predominance on legs and forearms. Several washings of sheets did not prevent dermatitis; it persisted up to 8 wk after sheets removed	[10]
Copper sulfate	110 patients patch tested; 8 of 69 who reacted had follicular or poral (folliculoporal) reactions	[2]
Cosmetic creams	5 young women in a 3 mo period; at sites where cream applied following bathing or before sun exposure: extensor limbs (with well developed vellus hairs) were greatly affected	[1]
Dander (human)	Patch test reactions to dander histologically showed eczematous changes in the upper parts of hair follicles and clinically consisted of erythema and papules; they were positive in 120 of 181 atopic patients, 2 of 28 allergic contact dermatitis patients, and 1 of 31 normal controls	[14]
Formaldehyde	A postal employee with right foot and bilateral popliteal dermatitis; patch test showed folliculoporal reaction 2 women developed textile contact dermatitis to a new long sleeved shirt and new pajamas; a hair usually pierced the center of the papular lesions Positive patch test reactions frequently showed a follicular pattern; in some patients, only bright red follicular papules set in a background of normal appearing skin	[2,8,15]
Homomenthyl salicylate	Sunscreening chemical in a suntan lotion; 2 women with follicular dermatitis. One of the woman developed consort allergic contact dermatitis from contact with her boy friend who used the lotion; she was originally misdiagnosed as having recurrent disseminated infundibulofolliculitis	[6]
Methyl glucose sesquistearate	Follicular dermatitis developed to both a lotion and facial cream that contained this chemical	[16]
Neomycin	Repeat topical application on abdomen (current report) and patch test reaction (woman with atopy and left arm dermatitis that flared after applying neomycin ointment	[7,9]
Nickel sulfate	A farm helper who sprayed trees with chemical and had an exudative dermatitis; patch test showed folliculoporal reaction 29 follicular patch test reactions in 853 heavy metal workers that were tested Female production line worker with dermatitis of hands, chest and face after exposed to metals and cutting fluids and patch test positive to nickel; she developed follicular contact dermatitis in her pubic area 2 d after shaving with a metal razor blade	[2,17,18]
Paraphenylenediamine	An atopic woman with recurrent episodes of follicular-based pruritic papules on her face, chest and back beginning 3 wk after starting daily oral hydrochlorothiazide; she had a similar dermatitis after contact with “black hair dye” and positive patch test reaction to paraphenylenediamine (which cross reacts with her new oral antihypertensive)	[19]
Polyoxyethylene laurylether	An emulsifier (and an addition of lauryl alcohol and ethylene oxide) used in cosmetics. A woman developed pruritic follicular facial papules after starting to use new cosmetics; both a use test and a patch test for polyoxyethylene lauryether showed a follicular papular reaction	[20]
Potassium dichromate	61 follicular patch test reactions in 853 heavy metal workers that were tested	[3]
Selenium salts	In glass industry, 4 employees exposed to barium and sodium selenite suffered from dermatitis and/or conjunctivitis; 2 of the patients developed follicular allergic contact dermatitis with papulo-follicular lesions. Patch testing with sodium selenite confirmed the diagnosis	[21]
Sodium tungstate	3 follicular patch test reactions in 853 heavy metal workers that were tested; heavy metal contains about 90% tungsten carbide	[3,18]
Tocopheryl linoleate	Vitamin E derivative added to base formulation of a cosmetic line in Switzerland; 905 patients with papular and follicular dermatitis. Positive patch test reactions to cosmetics and vitamin E linoleate	[4,5]

Table 2 Agents associated with irritant follicular contact dermatitis

Agent	Comment	Ref.
Beetle toxin	Pederin toxin released as a defensive mechanism from the rove (staphylinid) beetle in hot tropical and moderate climate regions typically limited to uncovered body areas	[22,23]
Bis-hydroxyethyl-tallow amine	Antistatic agent used to impregnate plastic tote boxes; outbreak of the hand or arms of 48.3% (14 of 29) of employees of the incoming inspections department of a microelectronic plant. The chemical provoked both follicular and nonfollicular irritant dermatitis; it was also a potential skin sensitizer	[24]
Coal-tar products	Hand dermatitis presenting with follicular papules and pustules at the site of exposure to coal-tar oils, creosote, pitch	[25]
Croton oil	Occupational source for irritant pustular and follicular irritant contact hand dermatitis	[25]
Debromoaplysiatoxin	Occurs after swimming in water contaminated by sea algae (Lyngbya majuscule Gomont); the alga cause a seaweed dermatitis in persons swimming off the coastin Oahu, Hawaii. Topical application of the toxin produces an irritant pustular folliculitis	[26]
Fluorine	Antirust solution containing 20% ammonium bifluoride diluted in water; acute irritant contact dermatitis in an atopic child. Rusted buckles of the right shoe cleaned with solution; 12 h later, the 19-mo-old boy developed an erythematous pustular dermatitis on the areas of the treated buckles	[27]
Greases	Occupational source for irritant pustular and follicular irritant contact hand dermatitis	[25]
Naphthalones	Occupational source for irritant pustular and follicular irritant contact hand dermatitis	[25]
Petroleum	Hand dermatitis presenting with follicular papules and pustules at the site of exposure to petroleum derivatives: crude oil and fractions, cutting oils; lesions develop at the contact site to oil-soaked and tar-soaked clothes	[25]
Propylene glycol	It is used as a solvent, a plasticizer, a component of household products, a food additive and an ingredient in cosmetics and pharmaceutical preparations. 45138 patients patch tested; only 1044 (2.4%) patients with actual allergic contact dermatitis and 43 (0.10%) patients with non-allergic follicular reactions	[28]
Tri-phenyl-tin-fluoride	It is a bioactive organo-tin compound used as agricultural fungicides, general biocides, bactericides, herbicides, insecticides and antifoulant in boat paints (ship bottom coatings); it is moderately toxic to the skin. The patient’s forearm accidentally contacted an empty drum that was still contaminated with the chemical; within 2 d he developed multiple follicular keratosis-like red papules evenly distributed over the affected area	[11]
Tocopheryl linoleate	Vitamin E derivative added to base formulation of a cosmetic line in Switzerland; 905 patients with papular and follicular dermatitis. In a few patients, the skin reaction appeared after a few applications on discontinuous days or more rarely after a single application suggesting an irritation reaction	[4,5]

Table 3 Clinical differential diagnosis of follicular contact dermatitis

Drug eruption

Fiberglass dermatitis

Food allergy

Hyperkeratosis follicularis et follicularis in cutem penetrans (Kyle’s disease)

Infundibulofolliculitis

Keratosis follicularis (Darier’s disease)

Keratosis pilaris

Perforating folliculitis

Pityriasis rubra pilaris

Scabies

Viral exanthema