Follicular Occlusion Triad: A Case Report

Follicular occlusion triad (FOT) is a complex chronic inflammatory skin disease comprising hidradenitis suppurativa (HS), acne conglobata (AC), and dissecting cellulitis of the scalp (DCS; Hoffman’s disease or perifolliculitis capitis abscedens et suffodiens). While pathological mechanisms are responsible for common skin manifestations, the exact underlying causes of follicular occlusion have not yet been clearly identified. Therefore, the diagnosis and treatment of FOT remain challenging. A 31-year-old man on conservative treatment for previously diagnosed HS and AC presented to our clinic with multiple masses on his posterior neck and face. Excisional biopsy of the masses revealed epidermal cysts. Four months after the surgery, he presented with a painful palpable mass around the occipital region of the scalp with characteristic skin manifestations such as cicatricial alopecia and comedones and was diagnosed with DCS. Incision and drainage of the lesion were performed, and histopathology revealed pathological findings of follicular occlusion. The patient was diagnosed with FOT. Following the procedure, the patient has been on regular follow-up and is on oral isotretinoin; there have been no complications for the last 6 months.