This letter to the editor highlights follicular psoriasis (FP), a rare variant of psoriasis, with a particular focus on its manifestation in a 58-year-old diabetic woman in Brazil. The patient presented with erythematous, keratotic, exclusively follicular papules, initially misdiagnosed as other dermatological conditions. Despite therapeutic attempts with antibiotics, the condition persisted until a correct diagnosis was reached via histopathological examination, confirming FP. Treatment with acitretin resulted in improvement after two months. The letter emphasizes the importance of recognizing this variant, particularly in populations with higher melanin levels, where follicular involvement in psoriasis might be overlooked.

The authors also provide insights into the histopathological characteristics of FP, distinguishing it from bacterial folliculitis and highlighting the chronic nature of the condition. They suggest that FP may represent an early stage of psoriasis and stress the need for clinical suspicion, especially in cases where standard treatments fail. This discussion underscores the significance of understanding dermatological variations across diverse populations, such as in Brazil, where under recognition of follicular psoriasis may occur due to its rarity and similarities with other skin disorders.

Reference: Souza BCE, Bandeira LG, Cunha TDAC, Valente NYS. Follicular psoriasis: an underdiagnosed entity? An Bras Dermatol. 2019;94(1):116-118. doi: 10.1590/abd1806-4841.20197987.