A 12-year old boy presented with a 2 months history of an itchy eruption
over the extremities. The patient complained of a cyclic course with
exacerbation in winter. There was no history of asthma, rhinitis or
atopic dermatitis. Examination revealed grouped follicular papules
forming discoid patches (Fig 1) predominantly over the
extensor aspect of forearms and legs. The papules were skin colored,
dome shaped and topped with pityriasiform scale. There was associated
generalized xerosis. Skin biopsy showed spongiotic dermatitis localised
to the upper portion of hair follicle. The patient was given a midpotent
steroid with emollient with complete resolution of the lesion in three
weeks.
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Fig. 1 A discoid patch formed due to
coalescence of the follicular lesions with excoriation marks on
the periphery.
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This condition is appropriately called follicular
eczema as the biopsy shows spongiosis while the morphology shows
follicular lesions. Other common differentials include keratosis pilaris
(diffuse, follicular keratotic lesions with perifollicular erythema),
lichen spinulosus (grouped, spiny, keratotic, papules) and phrynoderma
(diffuse, large, pigmented, keratotic papules).
