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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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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 ).
Human Ethics
Consent was obtained or waived by all participants in this study
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Case series
Patient 1 was a 24-year-old man with a 5-year history of FD that had been treated unsuccessfully with multiple antibiotics, dapsone, and systemic retinoids. The physical examination revealed a large area of cicatricial alopecia with numerous erosive lesions and some pustules ( Fig 2 , A). The symptoms (exudate and pain) caused severe functional impairment. Three sessions of textile PDT at 37 J/cm 2 were performed at 1-week intervals. Systemic retinoids were stopped on the day of the first PDT session. Tolerance was excellent during the illumination (VAS, 0/10). A few crusts and light erythema spontaneously resolved within 2 days after the treatment. Favorable treatment outcomes were noticeable at 3-month follow-up. There were clear reductions in pain, burning, and oozing, and the pustules had resolved ( Fig 2 , B). The alopecia was relatively stable, with a slight progression at the center of the alopecic area. Control of the disease lasted for 4 months. Adalimumab 40 mg every 2 weeks was then prescribed, allowing stabilization of the disease.
A, Before photodynamic therapy: numerous erosive lesions, oozing, and inflammation. B, Evolution at 3 months after 3 sessions of textile photodynamic therapy: decrease in erosive lesions, oozing, and inflammation and stability of alopecia.
Patient 2 was a 37-year-old man who received a diagnosis of FD 10 years previously. He had been treated with systemic retinoids and topical and systemic antibiotics without any improvement. He had had no treatment in the past year. The physical examination showed a cicatricial alopecic area, with pustules and crusts on the periphery ( Fig 3 , A). Three sessions of textile PDT at 12 J/cm 2 were performed at 1-month intervals. Tolerance was excellent (VAS, 0/10). Light erythema and edema were noted after each illumination. The evolution was favorable at 3 months, with a decrease of symptoms such as pain and burning and stability of the alopecic area ( Fig 3 , B). Systemic retinoids were then prescribed for a period of 6 months, allowing stabilization of the disease. At 2 years of follow-up, the disease was stable and the patient only applied topical moisturizers.
