Objectives: Dissecting folliculitis (DF) of the scalp is a chronic, suppurative scalp disease on the background of follicular dysfunction, and an aberrant cutaneous immune response to commensal bacteria resulting in extensive scarring and irreversible alopecia. DF can exist as an isolated disease or in the form of acne tetrad sharing similar pathogenesis and histology with acne. DF has been successfully treated with oral tetracyclines and isotretinoin. Method: We present a 13-year-old male patient with DF. Extensive laboratory work-up including skin swabs was normal. On examination, multiple slightly erythematous to skin coloured round nodules measuring up to 30mm in diameter with overlying alopecia were observed in the scalp. Clinical diagnosis was confirmed by skin biopsy. Results: The histology showed unremarkable epidermis, extensive granulomatous inflammation in the subcutis, and small perifollicular and periadnexal epitheloid granulomas consisting of histiocytes surrounded by lymphocytes in the dermis. Special staining, APAS, Giemsa, Gomori and immunohistochemistry panel CK-PAN, CD68, S-100, CD1a were negative. Treatment with doxycycline failed to improve the lesions, therefore isotretinoin 0.5 mg/kg/day was introduced with resolution of inflammatory lesions and complete regrowth of significantly darker lesional hair compared to patient's natural shade of brown. Discussion: Pigmentary hair changes have been observed following chemotherapy, molecular targeted therapies, immunotherapies, radiotherapy, stem cell transplant and endocrine therapies, nevertheless the underlying mechanisms are still incompletely understood. Retinoids are known to cause various hair disorders, and the increased and unusual hair follicle pigmentation like observed in our patient, could be a new class specific adverse-event.