Disseminate and recurrent infundibulofolliculitis

Disseminate and recurrent infundibulofolliculitis (DRIF) is also known as Hitch and Lund disease after the pair who first described this condition in 1968. It is a rare condition, mostly described as occurring in those of African descent.

Clinical presentation

This condition typically presents as a widespread, mildly itchy, follicular rash (arising within the hair follicle). It has been described as ‘goose bumps through a magnifying glass’. The rash is slightly pink in appearance often with a brown, pigmented edge. The torso, neck and arms are most affected.

Infundibulofolliculitis

Histology

There is oedema (swelling) and lymphocytic infiltration (inflammation) around the infundibulum and basal region of the hair follicle. There is widening and proliferation of cells in the upper part of the follicle with variable amounts of scale formation. The direct immunofluorescence test is negative i.e. antibodies cannot be detected around the hair follicle.

Prognosis

Other than its appearance and in some, the itch, there are no serious consequences of this rash. Despite the name, not everyone has recurrent episodes, as a persistent rash is more usual. It generally resolves after some years.

Treatment

There is little response to topical, intralesional or systemic steroids, antibiotics such as doxycycline, or antihistamines. There are reports of improvement with oral vitamin A, isotretinoin, and PUVA.