Acne vulgaris in general population of rural western Kenya: cross‐sectional community survey

use of isotretinoin 40 mg daily for 4 months. The patient did not tolerate doxycycline. The patient did not wish to use cyclosporine, mycophenolate mofetil, or other systemic immunosuppressive medications. The rate of the patient’s hair loss slowed with use of intralesional triamcinolone 5 mg/ml every 6–12 weeks. This case documents a second report of the association between GLPLS and androgen insensitivity syndrome (testicular feminization). In both cases, scalp alopecia began in early adulthood. This may be earlier than the typical age for scalp alopecia in GLPLS that is not associated with androgen insensitivity. Furthermore, in these two cases, follicular eruption on the body preceded the scalp disease. Thus, GLPLS occurring in the context of androgen insensitivity syndrome might not follow the typical order of symptom appearance, namely cicatricial alopecia of the scalp, followed by non-scarring alopecia of the axillae and groin followed by follicular keratosis on the trunk and extremities. Treatment of GLPLS is challenging. Hydroxychloroquine has efficacy in the treatment of lichen planopilaris. More recently, the peroxisome proliferator activated receptor a agonist, pioglitazone, was shown to have benefit in patients with lichen planopilaris. The drug has subsequently been withdrawn from many markets (France, Germany) because of its risk for bladder cancer. However, none of these medications was helpful for the patient. The previous report of GLPLS did not describe treatment of the patient so it remains unknown as to whether GLPLS associated with androgen insensitivity is more challenging to treat than other forms of GLPLS. Certainly, this was our experience for this patient. The pathogenesis of GLPLS in androgen insensitivity syndrome is unknown. Further studies are needed to determine the incidence of hair loss and hair follicle abnormalities in patients with androgen insensitivity.