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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
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)
Summary
Folliculitis delcavans is a rare ailment that causes red, swollen patches on your scalp. The patches destroy your hair follicles, causing scars and permanent hair loss at the affected sites.
While there is no known cause, the problem is linked to a bad response to Staphylococcus A. bacteria. It is believed that the bacteria trigger an extreme immune response that causes symptoms.
Treatments can reduce symptoms and slow the damage to hair follicles. The nature and chronic course of this problem can also have a negative impact on those who have it. Enduring long-term treatment only to have the problem recur can be difficult. This can also have an impact on your self-image and affect your quality of life.
Working with your healthcare provider and a counselor can help you manage the mind and body aspects of this problem. Despite its long course, the outlook is good for most cases.
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Introduction
Acne keloidalis nuchae (AKN) also known as folliculitis keloidalis nuchae (FKN) is one of the chronic forms of scarring folliculitis seen mostly in men of African descent. 1 Although the term “folliculitis keloidalis nuchae” captures the follicular nature of the disorder and is preferred by some, the lesions develop past the nuchal area suggested by the terminology. The term AKN is commonly used although it is generally agreed that the condition is not a keloid, and affected individuals do not have a tendency to develop keloids in other areas of the body. Acne keloidalis (AK) lesions do not have histological features suggestive of a keloids. 2
Hebra in 1860 first used the terminology sycosis framboesiformis although it had been described as a distinct entity in the late 1800s. 3 In 1869, Kaposi referred it to as dermatitis papillaris capillitii, and in 1872, Bazin coined the term AKN. 4 The exact cause of AKN remains unknown. The inciting agents appear to be multifactorial with various factors such as androgens, inflammation, infection, trauma, genetics, and ingrowing hairs being implicated. It shares some similar features with other forms of cicatricial alopecia and may occur together in the same individual. It has been classified as a mixed form of the primary cicatricial alopecia by the North American Hair Research Society. 5 It is characterized by papules, pustules, and sometimes tumorous masses in the nuchal or occipital regions of the scalp hence the name “bumps” evolved in the environment. 6 Despite its common occurrence, treatment may be challenging. This review highlights the epidemiology, clinical features, impact, and treatment challenges.
Epidemiology
AKN occurs majorly in those of African descent. It has been reported in a few Caucasians and other ethnic groups. 7 It is predominantly a disorder of males although there are a few reports in females with a male to female ratio of 20:1. 8 , 9 Reports from Nigeria give a prevalence ranging from 0.7% to 9.4%, 10 – 12 while in Benin in West Africa the prevalence is 0.7%. 13 In South Africa, a prevalence of 4.7% was seen in boys in their last year of school and 10.5% in older men. 14 In African-Americans, the reported prevalence ranges from 0.5% to 13.6%. 5 , 16 The latter was in American footballers who wore headgears for protection. Their Caucasian counterparts wearing the same headgears did not develop AKN.