Treatment of Anserine Folliculitis
Anserine folliculitis (traumatic anserine folliculosis) should be treated with topical retinoids as first-line therapy, combined with elimination of the causative friction or trauma, and supplemented with keratolytics if needed.
Clinical Recognition and Diagnosis
Anserine folliculitis presents as grouped follicular papules with a rough, sandpaper-like texture, typically on the face or neck in adolescents and young adults 1, 2. The condition is caused by repeated mechanical friction or pressure—commonly from habitual behaviors like resting the cheek on the palm. Diagnosis is clinical and can be confirmed with dermoscopy, avoiding the need for invasive biopsies 1.
The key diagnostic features to identify include:
- History of repetitive friction or pressure to the affected area
- Grouped follicular papules with hyperkeratotic plugs
- Rough texture resembling sandpaper
- Most commonly affects face (especially cheeks) or neck
- Dermoscopic findings showing follicular hyperkeratosis
Treatment Algorithm
Step 1: Eliminate Mechanical Trauma
Patient education is paramount—the causative friction must be stopped for treatment to succeed 2. Identify and eliminate the specific repetitive behavior (e.g., resting face on hand, rubbing, picking).
Step 2: Topical Retinoids (First-Line)
Apply topical retinoids once daily 1, 2. These work by normalizing follicular keratinization and reducing keratin plug formation. Start with lower concentrations if concerned about irritation, particularly in younger patients.
Step 3: Add Keratolytics if Needed
Topical keratolytics can be used in combination with retinoids for enhanced effect 2. Options include:
- Urea 10% cream
- Salicylic acid preparations
Step 4: Alternative Option - Vitamin D Analogs
Vitamin D analogs have shown good responses and can be considered as an alternative or adjunct to retinoids 1.
Important Caveats
Relapse is common once therapy is discontinued 1. This underscores the critical importance of eliminating the mechanical trigger—topical therapy alone without behavioral modification will likely fail.
The condition is benign and self-limited if the trauma is eliminated. Treatment duration typically requires several months; one case report documented marked improvement after nine months of combined therapy with friction avoidance 2.
What to Avoid
Do not perform invasive biopsies when clinical and dermoscopic findings are characteristic—this is an unnecessary procedure for a benign condition 1. Avoid greasy occlusive creams that may worsen follicular occlusion 3.