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eMedicine Specialties > Dermatology >Diseases of theAdnexa

FolliculitisAuthor: Elizabeth Kline Satter, MD, MPH, Chairman, Departmentof Dermatology, Naval Medical Center San DiegoContributor Information and Disclosures

Updated: Mar 3, 2010

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Overview

Differential Diagnoses & Workup

Treatment & Medication

Follow-up Multimedia

References

Keywords

Introduction

Background

Folliculitis is defined histologically as the presence of inflammatory cells within the wall and ostia of

the hair follicle, creating a follicular-based pustule. The actual type of inflammatory cells can vary

and may be dependent on the etiology of the folliculitis, the stage at which the biopsy specimenwas obtained, or both. The inflammation can be either limited to the superficial aspect of the follicle

with primary involvement of the infundibulum or the inflammation can affect both the superficial

and deep aspect of the follicle. Deep folliculitis can eventuate from chronic lesions of superficial

folliculitis or from lesions that are manipulated, and this may ultimately result in scarring.

Perifolliculitis, on the other hand, is defined as the presence of inflammatory cells in the

perifollicular tissues and can involve the adjacent reticular dermis. Folliculitis and perifolliculitis can

manifest independently or together as a result of follicular disruption and irritation.

Acne represents a noninfectious form of folliculitis. The follicular inflammation seen in acne occurs

as a secondary event as a result of follicular obstruction from abnormal keratinization. In acne, thesuperficial aspect of the follicle distends and is obstructed by a keratin plug. The sebum fills the

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follicle, and the normally commensal bacteria (Propionibacterium acnes) produces excess free

fatty acids, which trigger follicular inflammation.

Acne-related eMedicine articles include Acne Conglobata, Acne Fulminans,Acne Keloidalis

Nuchae, Acne Vulgaris, andAcneiform Eruptions.

Pathophysiology

Folliculitis is a primary inflammation of the hair follicle that occurs as a result of various infections,

or it can be secondary to follicular trauma or occlusion.

Eosinophilic folliculitis differs in that it is thought to occur as a result of an autoimmune process

directed against the sebocytes or some component of the sebum.

Although the etiology of papulopustular eruption secondary to epidermal growth factor receptor

(EGF-R) inhibitors is unknown, it is hypothesized to occur secondary to abnormal epidermal

differentiation that leads to follicular obstruction and subsequent inflammation.1,2

Frequency

United States

Superficial folliculitis is common, but because it is often self-limited, patients rarely present to the

doctor. Those who are seen more often have either recurrent/persistent superficial folliculitis or

have deep folliculitis. Although the incidence is unknown, certain conditions make patients more

susceptible. These include frequent shaving, immunosuppression, preexisting dermatoses, long-

term antibiotic use, occlusive clothing and/or occlusive dressings, exposure to hot humid

temperatures, diabetes mellitus, obesity, and use of EGF-R inhibitor medications.

Folliculitis has been reported following smallpox or anthrax vaccine. These cases may become

more common because more military troops are being deployed.3

Mortality/Morbidity

Although complications from folliculitis are uncommon, they include cellulitis, furunculosis,

scarring, and permanent hair loss.

Race

Folliculitis occurs in persons of any race, but pseudofolliculitis and traction folliculitis occurs more

commonly in African Americans and classic eosinophilic folliculitis is more common in Japanese

persons.4,5

Sex

For most cases of folliculitis, no data are available to indicate the presence of a sexual

predilection; however, eosinophilic folliculitis is reported to more frequently affect males and

Pityrosporum folliculitis may have a slightly increased female incidence.

Age

Folliculitis can be seen in persons of all ages.

Clinical

History
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The folliculitis patient typically reports an acute onset of papules and pustules associated with

pruritus or mild discomfort.

Patients with deep folliculitis usually experience more pain and may have suppurative drainage.

Persistent or recurrent lesions may result in scarring and permanent hair loss.

The papulopustular eruption secondary to EGF-R inhibitors typically occurs within the first 2 weeks

of the initiation of therapy and can be associated with pruritus, pain, and desquamation.

Physical

Patients with superficial folliculitis usually present with multiple small papules and pustules on an

erythematous base that are pierced by a central hair, although the hair may not always be

visualized. Deeper lesions manifest as erythematous, often fluctuant, nodules. Sometimes, a

patterned folliculitis occurs in areas that were shaved or occluded. Any hair-bearing site can be

affected, but the sites most often involved are the face, scalp, thighs, axilla, and inguinal area.

Folliculitis has been traditionally divided into superficial and deep forms; however, most superficialforms can evolve into the deep form. The most common superficial form of infectious folliculitis is

known as impetigo of Bockhart or barbers itch and is caused by Staphylococcus aureus, such as

the infection shown in the image below . The lesions are seen in the bearded area, often on the

upper lip near the nose, as erythematous follicular-based papules or pustules that may rupture and

leave a yellow crust. The pustule is often pierced by a hair that is easily extracted from the follicle.

This form of folliculitis occurs more commonly in carriers of nasal staphylococci. Another type of

superficial folliculitis caused by staphylococci is a sty, which only differs from typical folliculitis in

that it occurs on the eyelid.

A 22-month-old boy with a staphylococcal folliculitis on the buttocks. The lesions

have been excoriated. Diaper occlusion may have been related to onset of the

rash.

[CLOSE WINDOW]
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A 22-month-old boy with a staphylococcal folliculitis on the buttocks. The lesions

have been excoriated. Diaper occlusion may have been related to onset of the

rash.

When involvement of the follicle is more extensive, a follicular-centered dermal abscess results.

When the condition occurs on the face, it is referred to as sycosis barbae (vulgaris), but if it occurs

elsewhere, it is referred to as a furuncle or boil. A confluence of several furuncles results in a

carbuncle.6

Tinea barbae is an uncommon form of superficial folliculitis that clinically resembles its bacterial

counterpart; however, it is caused by a superficial infection by various zoophilic dermatophytes.

This superficial fungal folliculitis is most commonly seen in male farmers and typically affects one

side of the face in the submaxillary region or chin. Patients with more extensive involvement of the

follicle or those who experience an exaggerated hypersensitivity reaction to the dermatophyte

infection present with enlarged, boggy purulent plaques, called kerions, in the site of the prior

superficial infection. Another deep fungal folliculitis occurs on the legs of women who shave, andthis is calledMajocchi granuloma.

Gram-negative folliculitisprimarily occurs in patients on long-term antibiotic therapy, often

antibiotics given for the treatment of acne. This type of folliculitis arises from disequilibrium of the

normal skin bacteria in favor of gram-negative organisms such as Enterobacter, Klebsiella,

Escherichia, Serratia, and Proteus species. These lesions manifest as multiple small pustules that

are most pronounced in the perinasal region and can spread to the chin and cheeks.

Pseudomonal folliculitis is another gram-negative folliculitis and is also known as hot tub (spa)

folliculitis and wet suit folliculitis (see the images below). It appears 8-48 hours after exposure to

contaminated water or wet suits as erythematous follicular-based papules and pustules that aremost concentrated in areas occluded by swimwear. This form of folliculitis may be associated with
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systemic findings such as fever, headache, sore throat, malaise, or gastrointestinal distress, but it

is a self-limited condition that resolves in 7-14 days. Another similar condition is hot hand-foot

syndrome, which occurs in a similar clinical situation but eventuates in painful erythematous

nodules and papules on the palms and soles rather than folliculitis.7

A 30-year-old woman with hot tub folliculitis. She had used a hot tub 2 days

prior, wearing a bikini-style bathing suit.

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A 30-year-old woman with hot tub folliculitis. She had used a hot tub 2 days

prior, wearing a bikini-style bathing suit.

Pseudomonas folliculitis. Courtesy of Hon Pak, MD.

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Pseudomonas folliculitis. Courtesy of Hon Pak, MD.

Pityrosporum folliculitis is typically seen in young adults, with a slight female predominance, as

intensively pruritic small uniform papules and pustules on the back, chest, and shoulders. It occurs

more often in warm, humid climates and may be more frequent in immunocompromised patients or

in patients on long-term antibiotics. This eruption is due to follicular infection by Malassezia furfur,

which is a lipophilic yeast.

An unusual cause of folliculitis occurs as a result of either overgrowth ofDemodexmites or an

acquired hypersensitivity to the mite. This form of folliculitis manifests with a more diffuse

background erythema, in addition to the follicular-centered papules and pustules.8

An uncommon form of folliculitis is due to an infection with herpes viruses. This form of folliculitiscan be caused by an infection by herpes simplex viruses 1 and 2 and is found in areas adjacent to

a primary cold sore. It is spread by shaving. These lesions appear as grouped or scattered

vesicles.9,10

Varicella-zoster virus may also cause a primarily follicular-based infection. These patients present

with erythematous plaques in a dermatomal distribution; however, vesicles do not typically occur.

Biopsy is often required to confirm the diagnosis.10

Folliculitis can also have a noninfectious etiology caused by follicular trauma or occlusion or may

simply be idiopathic. For example,pseudofolliculitis barbae, also known as shaving or razor

bumps, occurs primarily in the bearded area of African American males or other racial groups withthick, coarse, curly hair. This condition is not a folliculitis per se, but rather a perifolliculitis that

arises as a result of the hair reentering the skin adjacent to its exit point from the follicle. The hair

then acts as a foreign body and incites inflammation. The inflammation can spontaneously resolve

if the hair is extracted or it can become associated with a chronic foreign body granulomatous

reaction and may result in scarring.

Acne keloidalis nuchae is a similar condition that arises on the neck and occipital region of the

scalp, but this condition is both a folliculitis and perifolliculitis and has greater potential for scarring.

Acute generalized exanthematous pustulosis and anticonvulsant hypersensitivity syndrome both

manifest as an acute onset of a discrete pustular eruption arising shortly after beginning therapy

with various medications. Although the eruption that occurs in acute generalized exanthematous
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pustulosis is often differentiated from anticonvulsant hypersensitivity syndrome by having

nonfollicular-based pustules, either condition can have follicular or nonfollicular-based pustules.

Papulopustular drug eruption due to EGF-R is a relatively new entity and consists of a follicular

eruption on the face, chest, and upper back that occurs approximately 2 weeks after initiation of

chemotherapy. It is seen in up to 90% of patients taking EGF-R inhibitors, and its presencecorrelates to a positive response to chemotherapy.1,2

The last noninfectious folliculitis to be discussed is eosinophilic folliculitis. It manifests as intensely

pruritic pustules and can occur in at least 3 different clinical situations. The first is the original

description of eosinophilic folliculitis, also know as Ofuji disease. It arises in Japanese males at an

average age of 30 years. The lesions initially begin as discrete papules and pustules that

eventually coalesce to form circinate plaques composed of a peripheral rim of pustules with central

clearing. These lesions appear cyclically on the face, back, and extensor surfaces of the arms and

spontaneously resolve in 7-10 days. Often, peripheral eosinophilia is present.5

A second form of eosinophilic folliculitis arises in patients with AIDS and other conditions that

result in immunosuppression.11This form is seen most often in adult males with a CD4+ count of

less than 300 cells/L. It is persistent and does not form an annular pattern. The lesions tend to

favor the face, scalp, and upper trunk.12

The last form of eosinophilic folliculitis occurs in infants, usually within the first 24 hours to first few

weeks of life. It is more common in male infants and usually is self-limited; however, as in Ofuji

disease, it may follow a cyclic course lasting months to years. The lesions primarily affect the scalp

and eyebrows. This form may also be associated with peripheral eosinophilia.

Causes

The causes of folliculitis are multiple and include infection, friction and other causes of folliculartrauma, excessive perspiration, and occlusion; however, many cases remain idiopathic. Patients

who have a reduced immune status, prior skin injury, or dermatoses or those who are obese may

be more at risk.

More on Folliculitis

Overview: FolliculitisDifferential Diagnoses & Workup: Folliculitis

Treatment & Medication: FolliculitisFollow-up: Folliculitis

Multimedia: Folliculitis

References

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References

1. Bragg J, Pomeranz MK. Papulopustular drug eruption due to an epidermal growth factorreceptor inhibitors, erlotinib and cetuximab. Dermatol Online J. 2007;13(1):1.[Medline].

2. Roe E, Garcia Muret MP, Marcuello E, Capdevila J, Pallares C, Alomar A. Description andmanagement of cutaneous side effects during cetuximab or erlotinib treatments: aprospective study of 30 patients. J Am Acad Dermatol. Sep 2006;55(3):429-37.[Medline].
http://tmp/sv716.tmp/javascript:showcontent('active','references');http://tmp/sv716.tmp/javascript:showcontent('active','references');http://tmp/sv716.tmp/javascript:showcontent('active','references');http://tmp/sv716.tmp/javascript:showcontent('active','references');http://tmp/sv716.tmp/javascript:showcontent('active','references');http://tmp/sv716.tmp/javascript:showcontent('active','references');http://tmp/sv716.tmp/javascript:showcontent('active','references');http://tmp/sv716.tmp/javascript:showcontent('active','references');http://tmp/sv716.tmp/javascript:showcontent('active','references');http://tmp/sv716.tmp/javascript:showcontent('active','references');http://tmp/sv716.tmp/javascript:showcontent('active','references');http://tmp/sv716.tmp/javascript:showcontent('active','references');http://tmp/sv716.tmp/javascript:showcontent('active','references');http://emedicine.medscape.com/article/1070456-diagnosishttp://emedicine.medscape.com/article/1070456-treatmenthttp://emedicine.medscape.com/article/1070456-followuphttp://emedicine.medscape.com/article/1070456-mediahttp://tmp/sv716.tmp/javascript:showcontent('active','references');http://emedicine.medscape.com/article/1070456-diagnosishttp://emedicine.medscape.com/article/1070456-printmailto:enter%20email%20address%20here?Subject=eMedicine%20Article%20-%20Folliculitis&Body=I%20thought%20you%20might%20be%20interested%20in%20this%20article%20from%20eMedicine.%20You%20may%20either%20click%20on%20the%20following%20link%20or%20copy%20and%20paste%20it%20into%20your%20browser.%0Dhttp://emedicine.medscape.com/article/1070456-overview%0D%0A%0D%0AeMedicine%20is%20the%20leading%20provider%20of%20clinical%20medical%20information%20for%20medical%20professionals%20and%20consumers.%20To%20explore%20eMedicine%20today,%20visit%20http://emedicine.medscape.comhttp://tmp/sv716.tmp/javascript:showcontent('inactive','references');http://tmp/sv716.tmp/javascript:showcontent('inactive','references');http://tmp/sv716.tmp/javascript:showcontent('inactive','references');http://www.medscape.com/medline/abstract/17511934http://www.medscape.com/medline/abstract/17511934http://www.medscape.com/medline/abstract/16908348http://www.medscape.com/medline/abstract/16908348mailto:enter%20email%20address%20here?Subject=eMedicine%20Article%20-%20Folliculitis&Body=I%20thought%20you%20might%20be%20interested%20in%20this%20article%20from%20eMedicine.%20You%20may%20either%20click%20on%20the%20following%20link%20or%20copy%20and%20paste%20it%20into%20your%20browser.%0Dhttp://emedicine.medscape.com/article/1070456-overview%0D%0A%0D%0AeMedicine%20is%20the%20leading%20provider%20of%20clinical%20medical%20information%20for%20medical%20professionals%20and%20consumers.%20To%20explore%20eMedicine%20today,%20visit%20http://emedicine.medscape.comhttp://emedicine.medscape.com/article/1070456-printhttp://tmp/sv716.tmp/javascript:showcontent('active','references');http://tmp/sv716.tmp/javascript:showcontent('active','references');http://tmp/sv716.tmp/javascript:showcontent('active','references');http://tmp/sv716.tmp/javascript:showcontent('active','references');http://tmp/sv716.tmp/javascript:showcontent('active','references');http://emedicine.medscape.com/article/1070456-diagnosishttp://emedicine.medscape.com/article/1070456-treatmenthttp://emedicine.medscape.com/article/1070456-followuphttp://emedicine.medscape.com/article/1070456-mediahttp://tmp/sv716.tmp/javascript:showcontent('active','references');http://emedicine.medscape.com/article/1070456-diagnosishttp://emedicine.medscape.com/article/1070456-printmailto:enter%20email%20address%20here?Subject=eMedicine%20Article%20-%20Folliculitis&Body=I%20thought%20you%20might%20be%20interested%20in%20this%20article%20from%20eMedicine.%20You%20may%20either%20click%20on%20the%20following%20link%20or%20copy%20and%20paste%20it%20into%20your%20browser.%0Dhttp://emedicine.medscape.com/article/1070456-overview%0D%0A%0D%0AeMedicine%20is%20the%20leading%20provider%20of%20clinical%20medical%20information%20for%20medical%20professionals%20and%20consumers.%20To%20explore%20eMedicine%20today,%20visit%20http://emedicine.medscape.comhttp://tmp/sv716.tmp/javascript:showcontent('inactive','references');http://www.medscape.com/medline/abstract/17511934http://www.medscape.com/medline/abstract/16908348


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3. Walsh SR, Johnson RP. Vaccinia Folliculitis After Primary Dryvax Vaccination. Infect DisClin Pract. Mar 2007;15(2):132-4.

4. Fox GN, Stausmire JM, Mehregan DR. Traction folliculitis: an underreportedentity. Cutis. Jan 2007;79(1):26-30. [Medline].

5. Nervi SJ, Schwartz RA, Dmochowski M. Eosinophilic pustular folliculitis: a 40 year

retrospect. J Am Acad Dermatol. Aug 2006;55(2):285-9. [Medline].

6. Eley CD, Gan VN. Picture of the month. Folliculitis, furunculosis, and carbuncles.ArchPediatr Adolesc Med. Jun 1997;151(6):625-6.[Medline].

7. Yu Y, Cheng AS, Wang L, Dunne WM, Bayliss SJ. Hot tub folliculitis or hot hand-footsyndrome caused by Pseudomonas aeruginosa. J Am AcadDermatol. Oct 2007;57(4):596-600. [Medline].

8. Dong H, Duncan LD. Cytologic findings in Demodex folliculitis: a case report and review ofthe literature. Diagn Cytopathol. Mar 2006;34(3):232-4.[Medline].

9. Boer A, Herder N, Winter K, Falk T. Herpes folliculitis: clinical, histopathological, andmolecular pathologic observations. Br J Dermatol. Apr 2006;154(4):743-6.[Medline].

10. Weinberg JM, Mysliwiec A, Turiansky GW, Redfield R, James WD. Viral folliculitis.Atypical presentations of herpes simplex, herpes zoster, and molluscumcontagiosum.Arch Dermatol. Aug 1997;133(8):983-6.[Medline].

11. Zancanaro PC, McGirt LY, Mamelak AJ, Nguyen RH, Martins CR. Cutaneousmanifestations of HIV in the era of highly active antiretroviral therapy: an institutionalurban clinic experience. J Am Acad Dermatol. Apr2006;54(4):581-8.[Medline].

12. Majors MJ, Berger TG, Blauvelt A, Smith KJ, Turner ML, Cruz PD Jr. HIV-relatedeosinophilic folliculitis: a panel discussion. Semin Cutan Med Surg. Sep 1997;16(3):219-23. [Medline].

13. Vary JC Jr, Colven R, Kirby P. Hypertrophic scars from surgical staples mimickingfolliculitis. J Am Acad Dermatol. Jan 2010;62(1):157-8. [Medline].

14. Weedon D, Strutton G. Skin Pathology. 2nd ed. New York, NY: ChurchillLivingstone; 2002:459-66.

15. Satoh T, Shimura C, Miyagishi C, Yokozeki H. Indomethacin-induced reduction in CRTH2in eosinophilic pustular folliculitis (Ofuji's disease): a proposed mechanism of action.ActaDerm Venereol. 2010;90(1):18-22.[Medline].

16. Arenas R, Toussaint S, Isa-Isa R. Kerion and dermatophytic granuloma. Mycological andhistopathological findings in 19 children with inflammatory tinea capitis of the scalp. Int JDermatol. Mar 2006;45(3):215-9. [Medline].

17. Arndt KA, Robinson JK, Wintroub BU, LeBoit PE. Dermatology: Cutaneous Medicine andSurgery in Primary Care. Philadelphia, Pa: WB Saunders; 1997.

18. Bolognia JL, Jorizzo JL, Rapini RP. Dermatology. Vol 1. St. Louis, Mo: Mosby; 2003:553-66.

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Further Reading

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Keywords

folliculitis, superficial folliculitis, deep folliculitis, infectious folliculitis, Staphylococcus aureus,Pseudomonas, gram-negative bacteria, herpes, dermatophytes, Pityrosporum, Demodex,perifolliculitis, impetigo of Bockhart, barbers itch, sty, sycosis barbae, sycosis barbae vulgaris,furuncle, carbuncle, acute generalized exanthematous pustulosis, tinea barbae, Majocchigranuloma, kerion, eosinophilic folliculitis, pseudofolliculitis barbae, shaving bumps, razor bumps,acne keloidalis nuchae
http://www.medscape.com/medline/abstract/17330618http://www.medscape.com/medline/abstract/16844513http://www.medscape.com/medline/abstract/16844513http://www.medscape.com/medline/abstract/9193252http://www.medscape.com/medline/abstract/9193252http://www.medscape.com/medline/abstract/17658195http://www.medscape.com/medline/abstract/16548003http://www.medscape.com/medline/abstract/16548003http://www.medscape.com/medline/abstract/16536821http://www.medscape.com/medline/abstract/16536821http://www.medscape.com/medline/abstract/9267244http://www.medscape.com/medline/abstract/9267244http://www.medscape.com/medline/abstract/16546578http://www.medscape.com/medline/abstract/16546578http://www.medscape.com/medline/abstract/9300633http://www.medscape.com/medline/abstract/9300633http://www.medscape.com/medline/abstract/20082900http://www.medscape.com/medline/abstract/20082900http://www.medscape.com/medline/abstract/20107720http://www.medscape.com/medline/abstract/20107720http://www.medscape.com/medline/abstract/16533218http://tmp/sv716.tmp/javascript:showcontent('inactive','furtherreading');http://tmp/sv716.tmp/javascript:showcontent('inactive','furtherreading');http://tmp/sv716.tmp/javascript:showcontent('inactive','furtherreading');http://tmp/sv716.tmp/javascript:showcontent('inactive','synonymskeywords');http://tmp/sv716.tmp/javascript:showcontent('inactive','synonymskeywords');http://tmp/sv716.tmp/javascript:showcontent('inactive','synonymskeywords');http://www.medscape.com/medline/abstract/17330618http://www.medscape.com/medline/abstract/16844513http://www.medscape.com/medline/abstract/9193252http://www.medscape.com/medline/abstract/17658195http://www.medscape.com/medline/abstract/16548003http://www.medscape.com/medline/abstract/16536821http://www.medscape.com/medline/abstract/9267244http://www.medscape.com/medline/abstract/16546578http://www.medscape.com/medline/abstract/9300633http://www.medscape.com/medline/abstract/20082900http://www.medscape.com/medline/abstract/20107720http://www.medscape.com/medline/abstract/16533218http://tmp/sv716.tmp/javascript:showcontent('inactive','furtherreading');http://tmp/sv716.tmp/javascript:showcontent('inactive','synonymskeywords');


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Contributor Information and Disclosures

Author

Elizabeth Kline Satter, MD, MPH, Chairman, Department of Dermatology, Naval Medical CenterSan Diego

Elizabeth Kline Satter, MD, MPH is a member of the following medical societies:Alpha OmegaAlphaandAmerican Medical Women's AssociationDisclosure: Nothing to disclose.

Medical Editor

Daniel J Hogan, MD, Clinical Professor of Internal Medicine (Dermatology), NOVA SoutheasternUniversity; Investigator, Hill Top Research, Florida Research CenterDaniel J Hogan, MD is a member of the following medical societies:Alpha Omega Alpha,American Academy of Dermatology,American Contact Dermatitis Society, andCanadianDermatology AssociationDisclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech UniversityHealth Sciences CenterMichael J Wells, MD is a member of the following medical societies:Alpha Omega Alpha,American Academy of Dermatology,American Medical Association, andTexas MedicalAssociationDisclosure: Nothing to disclose.

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine,Fletcher Allen Health Care, University of VermontPaul Krusinski, MD is a member of the following medical societies:American Academy ofDermatology, American College of Physicians, andSociety for Investigative DermatologyDisclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor,Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics,University of PennsylvaniaJoel M Gelfand, MD, MSCE is a member of the following medical societies: Society forInvestigative DermatologyDisclosure: AMGEN Consulting fee Consulting; AMGEN Grant/researchfunds Investigator; Genentech Grant/research funds investigator; Centocor Consultingfee Consulting; Abbott Grant/research funds investigator; Abbott Consultingfee Consulting; Novartis investigator; PfizerGrant/researchfunds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/researchfunds investigator

Chief EditorDirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical CenterDirk M Elston, MD is a member of the following medical societies: American Academy ofDermatologyDisclosure: Nothing to disclose.

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