Dermatitis cruris pustulosa et atrophicans (DCPA) is a chronic, treatment-resistant scarring folliculitis that primarily affects young adults living in tropical regions.

While the etiology remains unclear and is likely multifactorial, it has been associated with trauma, occlusion, occupational exposures, seasonal exacerbation, and hypergammaglobulinemia. Staphylococcus aureus is often isolated on bacterial cultures, but DCPA is often resistant to antistaphylococcal therapy and an abnormal neutrophilic response to the organism is postulated pathogenetically.

DCPA follows a progressive, relapsing-remitting course over months to years. Early eruptions present as follicular pustules of the lower legs. Progressive disease results in rough, wiry hair and, ultimately, permanent atrophy and cicatricial alopecia of the affected skin. DCPA may be accompanied by pruritus or burning, edema, scaling, and eczematous changes.

Reported incidence in tropical areas is approximately 4%, although the true incidence is likely higher due to underreporting and limited access to medical care. The condition is most common in Asia and Africa, and cases have rarely been documented outside tropical climates. Age of presentation is typically in the second to third decades of life, and there is a predilection for males.