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Treatment for Folliculitis Decalvans
Treatment for folliculitis decalvans varies by individual in its effectiveness. The goal of treatment is to encourage disease remission (no symptoms). Most therapies can be administered at home, though some may require outpatient visits to a healthcare provider.
For most people, treatment involves a combination of topical solutions and/or oral antibiotics. It is a lengthy process because this condition can return after a course of successful therapy and trigger a recurrence of symptoms.
There is no specific treatment approved for folliculitis decalvans, so there is a wide range of approaches. The following therapies are the most common:
Antibiotics
Systemic antibiotics are regarded as the first-line treatment for folliculitis decalvans because they can eradicate Staphylococcus aureus. Though these treatments can be effective, symptoms often relapse after the interruption of therapy. Antibiotic resistance is also a concern with long-term use.
The following antibiotics are the most common:
- Oral tetracyclines :
- Minocin, Solodyn, others ( minocycline )
- Vibramycin -D, Efracea ( doxycycline )
- Adoxa, Declomycin , others (tetracycline)
- Tetralysal ( lymecycline )
- Rifadin, Rimactane ( rifampicin ) with or without Cleocin ( clindamycin ) (oral)
- First-generation cephalosporins:
- cephalexin oral
- Velosef ( cephradine oral)
- Duricef ( cefadroxil oral)
- Ancef ( cefazolin ) (intravenous and intramuscular)
Corticosteroids
Corticosteroids can help manage symptoms of itching, pain, and inflammation. They are also effective in treating the scar tissue common with folliculitis decalvans.
- Topical products (creams, gels, and ointments applied over the surface of the affected area)
- Intralesional injection (injection into a lesion)
- Systemic treatments (administered orally or intravenously for treatment throughout your body)
Introduction
Folliculitis decalvans (FD), often known as scarring alopecia, is one kind of primary cicatricial alopecia. This uncommon skin disorder is the root cause of about 10% of primary cicatrizing alopecia cases. Inflammatory neutrophilic infiltrates and scarring that results in papules and pustules around hair follicles indicate it [1]. It primarily affects males in their middle years and is more prevalent in those with darker skin tones [2,3]. Although the actual etiology of the illness remains uncertain, Staphylococcus (S.) aureus has been proposed as a possible culprit. There are other factors, such as the genetic link, since the illness is caused by cytotoxins or superantigens that bind to major histocompatibility complex (MHC) II molecules and has been seen in several families [4].
According to a recent systematic review overviewing 20 studies, including 282 patients ,the authors observed lack of high quality of evidence regarding the efficacy of FD-specific treatments. Antibiotics like clindamycin, rifampicin, doxycycline and azithromycin, tacrolimus, external beam radiation, isotretinoin, human immunoglobulin, adalimumab, infliximab, long-pulse ND:Yag, and red light photodynamic therapy have been tested, but the studies lack quality of evidence. However, a combination of clindamycin and rifampicin was found to be the most commonly used treatment in reviewed studies [5]. The present report consisted management of FD using a combination of two drugs with early response and no remission for a longer duration.
Case presentation
A 20-year-old male from central India presented to the outpatient department of a tertiary care hospital with multiple painful pustules covering the crown and occipital areas of his scalp (Figure (Figure1). 1 ). The patient had no history of pruritus, hidradenitis suppurativa, acne, or scalp injuries. Multiple nodulocystic lesions and patches of hair loss over the occipital and crown region were noted during the clinical examination.
Figure 1
Multiple nodulocystic lesions are present on the occipital and crown area of the scalp (black arrows).
All laboratory tests, such as the fasting lipid profile, thyroid profile, liver function test, renal function test, total blood count, and other indicators of inflammation, were within normal ranges. No fungal growth was seen in the fungal culture. Methicillin-sensitive S. aureus was found in moderate amounts in the swabs taken from the intact pustules. Methicillin-sensitive S. aureus was also detected in pustule scalp bacterial cultures (Figures (Figures2, 2 , ,3 3 ).
Figure 2
Round (1-3 mm), golden-yellow colonies of Staphylococcus aureus on blood agar.Figure 3
Yellow-colored colonies of Staphylococcus aureus on mannitol salt agar (MSA).A diagnosis of FD was made for the patient based on the clinical presentation, examination, and culture results. The patient was prescribed topical ozenoxacin 2% lotion twice daily for one month and oral doxycycline 100 mg BD. At one-month follow-up, the patient showed a recession of nodulocystic lesions with reticular patches of alopecia and hair regrowth (Figure (Figure4 4 ).
Treatment of folliculitis decalvans by photodynamic therapy using a new light-emitting device: A case series of 4 patients
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Folliculitis decalvans (FD) is a rare condition that affects young people, with a slight predominance in males. The lesions start with follicular erythema that progresses to pustules. The pustules evolve into a crust, leading to hair loss and scarring alopecia. The etiology of FD is unknown but could involve an inadequate immune response to Staphylococcus aureus, resulting in a chronic inflammatory reaction of the affected area. Treatment of FD can be challenging. The aim of the treatment is to stop the development of pustules and the extension of irreversible alopecia. However, because the disease is rare, we lack sufficient evidence on the efficacy of therapy. In clinical practice, systemic and topical antibiotics, retinoids, dapsone, zinc, and/or topical tacrolimus are generally used. 1 Some reports of treatment of FD with photodynamic therapy (PDT) have been published, with encouraging results. 2 , 3 These positive results may be due to the antibacterial and immunomodulation effects of PDT. 4 However, the use of this treatment is limited due to the variability of the illumination as well as the pain it causes, which is considered its main side effect. Moseley et al 5 showed that 2 commercial light-emitting devices did not provide uniform light and demonstrated that the fluence rate could be 30% lower than that delivered to the central zone at a distance of only 2 cm from the central zone. To overcome this disadvantage, the development of a flexible light source appears to be an interesting solution for nonplanar surfaces such as the scalp. Recently, a textile PDT device incorporating light-emitting fabric was developed ( Fig 1 , A and B). 6 The treatment of actinic keratosis with textile PDT showed promising results in terms of efficiency and tolerance (visual analog scale [VAS], 0.3/10). 7 Moreover, the flexible nature of this device appears to be well suited for use on curved surfaces such as the scalp, resulting in uniform illumination. 6
