Unique Presentation of the Follicular Occlusion Tetrad: A Case Report and Review of the Literature

The follicular occlusion tetrad is a chronic inflammatory complex that consists of four co-related conditions in which follicles are blocked with keratin rupture and lead to inflammation. These conditions include hidradenitis suppurativa (HS), acne conglobata (AC), dissecting cellulitis of the scalp (DCS), and pilonidal cyst (PC). Our unique case reports a 43-year-old female patient who presented with a 36-year history of all four elements of the tetrad after previous treatment with ciprofloxacin, spironolactone, and salicylic acid. Our case is notable as the patient presented after being on semaglutide for weight loss, as well as the first report of the full tetrad in a female patient. A comprehensive review of the follicular occlusion tetrad was conducted using current literature. The goal of the literature review was to provide a general overview of the patient population diagnosed with follicular occlusion tetrad. Additionally, weight loss medications were discussed as potential treatments for patients given the link between the disease and obesity. Further study is warranted to investigate the efficacy of newer therapies in managing patients.