Dermatitis cruris pustulosa et atrophicans (original) (raw)

2009, Indian Journal of Dermatology, Venereology and Leprology

infection being partial, secondary, not known or absent. For example, these include,conditions such as sycosis barbae and folliculitis decalvans. [1] Dermatitis cruris pustulosa et atrophicans (DCPA) is a distinctive type of chronic superficial folliculitis, of complex etiology, seen primarily in tropical countries. It primarily affects the anterior shins, with recurrent crops of itchy follicular pustules, which resolve either spontaneously or with treatment, resulting eventually in atrophy and loss of hair over the affected skin. The disease typically responds to a variety of topical and systemic antibiotics, but is characterized by recurrences that may be triggered by a variety of factors. Thus, DCPA has several unique features that distinguish it from banal pustular folliculitis, such as its peculiar localization to the legs, extreme chronicity, resistance to therapy and inevitable alopecia and atrophy of the INTRODUCTION INTRODUCTION Pyodermas are common purulent infections of the skin caused mainly by Staphylococcus aureus and Streptococcus pyogenes. [1] Primary pyodermas may be follicular or nonfollicular. The common causes of superficial folliculitis are S. aureus, coagulasenegative staphylococci and physical or chemical irritation. S. aureus is among the most important causes of skin infections and serious, sometimes fatal, systemic disease. [1] Folliculitis of the skin may be superficial or deep, as in pyodermas caused by pyogenic organisms like S. aureus or due to other factors like irritation or occlusion. However, there are a number of inflammatory diseases involving the hair follicle, the etiology of which are complex or uncertain, with the role of bacterial ABSTRACT Dermatitis cruris pustulosa et atrophicans (DCPA) is a distinctive type of chronic superÞ cial folliculitis, primarily affecting the lower limbs. It is characterized by symmetrical follicular pustules of both legs, with cutaneous edema, resulting in alopecia, atrophy and scarring. It was Þ rst described by Clarke, from West Nigeria, in 1952 and well illustrated in his book "Skin diseases in the African," under the initial label of "Nigerian shin disease." Subsequently, it was described in India as well, in 1964, and continues to be a problem in dermatology clinics across the country. It is predominantly a disease of men and has a high prevalence in some geographical regions; up to 3-4% in Madras, South India. Some unique features that distinguish DCPA from banal pustular folliculitis include its peculiar localization to the legs, extreme chronicity, resistance to therapy and inevitable alopecia and atrophy of the involved skin, with little postinß ammatory hyper-or hypopigmentation. Further, even in the presence of extensive lesions, there are no systemic features. Coagulase-positive Staphylococcus aureus is known to have a role in the etiology of DCPA, but the exact etiopathogenesis still needs to be elucidated. Immunological postulates such as hypergammaglobulinemia have been put forward to explain the chronicity of the condition. A number of therapeutic agents have been tried in various studies, including cotrimoxazole, psoralen with ultraviolet A (PUVA) therapy, ciproß oxacin, pentoxifylline, rifampicin, dapsone, minocycline and mupirocin (topical) with variable success rates. Although a well-recognized entity in dermatology clinics in tropical countries, DCPA has received little attention in the dermatological literature and has only a few studies to its credit. Its unique clinical picture, unclear etiopathogenesis and resistance to therapy afford a vast scope for further investigation and study.