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The patient with fluctuant, tender nodules with overlying alopecia. (A and B) Posterior and lateral views to show enlarged nodules in the scalp.
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A 38-year-old male patient presented with 5-year history of inflammatory, boggy, fluctuant nodules over the upper occiput with recurrent foul-smelling discharge (Figure 1).
The scalp biopsy showing marked neutrophilic infiltrate of the hair follicles and deep dermis at low (A) and high (B) maginification.
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A scalp punch biopsy showed epidermal hyperkeratosis, marked neutrophilic infiltrate of the hair follicles and deep dermis, and focal areas with multinucleated giant cells and histocytes (foreign body giant cell reaction) (Figure 2).
(A) Before treatment. (B) After 2 months of therapy showing partial hair regrowth.
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At 2 months follow-up, decreased swelling and areas of hair regrowth were noted which is unusual in the primary cicatricial alopecias (Figure 3).