From the Department of Dermatopathology, University of Athens, Greece, and Department of Dermatology, Glasgow Royal Infirmary, UK
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A 40-year-old white man presented with asymptomatic, depressed, skin-colored changes of the face and neck. The lesions had gradually expanded over the previous 3 years. He denied any history of traumatization, burns, and acne, or other facial inflammatory skin changes. He was generally healthy and had been on no medication. The only diagnosis he had been given before was that of "acne scars" despite his clear history. On examination, depressed skin-colored lesions were seen on the cheeks, jawlines, chin, and the anterior aspect of the neck. Many of these changes had a linear configuration bilaterally, resembling Koebner's phenomenon (Fig. 1). The laboratory investigation included full blood count, erythrocyte sedimentation rate, serum ferrum, ferritin, urea, electrolytes, glucose, liver enzymes and urinalysis, which were found to be normal. Two skin biopsies were performed with 4-mm punches. The first revealed changes of the hair follicle in the sense that the fibrous root sheath was expanded and strands and branches of epithelium originating from the epithelial root sheath extended into it. These changes involved the superficial part and mid-portion of the pilar complex. The stroma around the affected hair follicle was loose with almost absent elastic fibers. There was also a mild perifollicular inflammatory infiltrate consisting of lymphocytes, histiocytes, and neutrophils (Fig. 2). The findings of the second biopsy were almost identical, but the epithelial changes of the hair follicle were less prominent (Fig. .3). There were no vascular changes and alcian blue stain for acid mucopolysaccharides was positive in the expanded perifollicular fibrous tissue.The patient was checked with double-contrast radiogram and sigmoidoscopy for colon polyps with no findings. Furthermore, there was no mention of similar skin problems, recurrent abdominal pain, or intestinal blood loss in his family history.Despite the unusual clinical picture, the histopathologic findings lead us safely to the diagnosis of fibrofolliculomas.