The follicular occlusion tetrad (FOT) refers to a group of four chronic, relapsing inflammatory disorders of the hair follicle. These conditions share a common pathophysiological mechanism of follicular hyperkeratinization, followed by follicular occlusion. These disorders often coexist or occur sequentially in the same patient and are characterized by recurrent abscess formation, sinus tract development, and scarring in regions rich in apocrine glands. [1] [2]
The tetrad comprises four interrelated disorders, each involving follicular occlusion, rupture, and secondary inflammation. [3]
- Hidradenitis suppurativa (HS): Chronic, relapsing inflammation of hair follicles in apocrine-bearing areas, producing nodules, abscesses, and sinus tracts. [4]
- Acne conglobata: Severe nodulocystic acne with interconnected abscesses and scarring, often involving the trunk and face.
- Dissecting cellulitis of the scalp: Suppurative scalp disorder characterized by painful nodules and scarring alopecia.
- Pilonidal disease: Recurrent sinus formation in the sacrococcygeal region caused by follicular occlusion and inflammation.
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