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August 1992

Fluctuant Nodules and Alopecia of the Scalp

Author Affiliations

Department of Dermatology, University of Genoa (Italy)

Arch Dermatol. 1992;128(8):1117-1118. doi:10.1001/archderm.1992.01680180111017

REPORT OF A CASE  A 21-year-old white man was seen because of a patch of alopecia on the vertex of his scalp. He had had acne during his adolescence; 2 years before he had undergone an incision of a "cyst" on his occiput. Scarring alopecia had ensued.Physical examination showed a nonscarring alopecic patch over a fluctuant nodule that was 2 cm across. Application of pressure disclosed numerous follicular openings draining pus. On his back were a number of comedones, furuncles, and old acneic scars. The nodule was incised and drained pus and bloody exudate. Erythromycin (1200 mg/d) was given, but in the following weeks two more nodules developed (Figs 1 and 2). A biopsy specimen was taken and revealed horny plugs in the infundibula of the hair follicles (Fig 3) and a polymorphous infiltrate around their deep portion (Fig 4). Routine laboratory test results were noncontributory.What is your

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