Dermatitis Cruris Pustulosa et Atrophicans: Scarring Alopecia Beyond Scalp Hair

Abstract

Dermatitis Cruris Pustulosa et Atrophicans (DCPA) was first described in 1952 in Nigeria and is nowadays regarded as a type of chronic folliculitis of tropical areas. It is often limited to the lower limbs of young adults, mostly in the second to third decades, with a unique clinical picture characterized by chronicity, relentless progression, therapy refractoriness, and permanent cicatricial changes. Trauma, occlusion, and microorganism selection contribute for its etiopathogenesis, which is deemed multifactorial but still incompletely understood. Despite its conspicuous clinical features, awareness of DCPA is apparently low, hence probably overlooked. We herein summarize the current state of knowledge regarding this distinct entity, and further present the first report in a patient from Bangladesh, and concurrently the first in Europe. Paucity of data, and unraveled definite etiology and treatment, highlight the need for further studies.

Keywords: Cicatricial alopecia; Dermatitis cruris pustulosa et atrophicans; Folliculitis.

Fig. 1

a Multiple pustules and lichenified papules and plaques on the lower limbs with scarring alopecia. b Greater amplification.

Fig. 2

a “Early lesion” − superficial folliculitis changes with a well-developed “wine glass”-shaped abscess on the follicular ostium with a hair shaft within. An accompanying neutrophilic infiltrate on the dermis can also be seen (HE. ×100). b “Later lesion” − a mixed infiltrate composed of lymphocytes and neutrophils, histocytes, and giant cells is seen above the lower hair follicle segments (HE. ×100).