Pijnlijke bulten op het hoofd

Perifolliculitis capitis abscedens et suffodiens (PCAS) is a therapy-resistant primary cicatricial alopecia, in which follicular hyperkeratosis plays a key role. Many therapeutic options have been documented, often with limited and unsatisfactory results. A combination treatment with isotretinoin and diamino-diphenyl sulphone, both given orally, seems to be an effective therapeutic option. In our outpatient clinic we saw a 36-year-old man with multiple painful erythematous nodules and cicatricial alopecia on the scalp, with a history of acne congobata and acne inversa. Based on the history and clinical presentation the patient was diagnosed with PCAS. Treatment with a combination of oral isotretinoin and oral diamino-diphenyl sulphone, followed by intralesional triamcinolone acetonide resulted in a mild clinical improvement and a marked reduction in pain. An overview of PCAS is also presented.