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Discussion
FD, an unusual neutrophilic infection of the scalp, is characterized by purulent follicular exudation that is painful and recurrent, resulting in primary cicatricial baldness. The existence of superantigens and an abnormal host defense mechanism is widely accepted. However, because the etiology of FD is uncertain, therapy is difficult [1-2]. In bacterial and fungal cultures, S. aureus was not always the only pathogen identified, only 50% of these patients had a positive result. Although non-antibacterial therapies have also been used for FD, eliminating S. aureus has been the main goal as it was thought to be the only pathogen in our situation that may cause FD [2,3].
Information about the efficacy of treatments tailored to each FD is still scarce. According to the American College of Physicians Treatment Grading Guidelines, Grade 3 is the highest evidence obtained in the evidence-based evaluation study on the effectiveness of current FD treatments as revealed in a systematic review assessing the efficacy of FD treatments. According to this review, the longest disease remission lasted 7.2 months on average, while the shortest remission period was three to six months. These results were obtained with modern medication regimens that included clobetasol lotion, intralesional triamcinolone, azithromycin, clindamycin, and rifampicin [5]. It was observed that the remission period of this disease could range from two to four years. Half of the patients needed maintenance doses or treatment continuation to prevent such remission [4-6].
In the present case report, ozenoxacin and doxycycline therapies were effective, and at the six-month follow-up, there was no recurrence. The non-antibiotic (anti-inflammatory or immunomodulatory ) properties of doxycycline have been hypothesized to be the reason for its usage in the treatment of FD, which could be attributed to its inhibition of the production of proinflammatory cytokines, inhibition of proinflammatory enzymes such as inducible nitric oxide synthetase and matrix metalloproteinases, downregulation of major histocompatibility complex (MHC) class II expression in microglia and macrophages, suppression of T cell proliferation and activation, and induction of tolerogenic dendritic cells [7].
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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- Rakowska A. A 36-year-old man with inflammatory lesions and crusts on the scalp. In: Waśkiel-Burnat A, Sadoughifar R, Lotti TM, Rudnicka L, eds. Clinical Cases in Scalp Disorders. Springer International Publishing, 2022:43-46.
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- Pimenta R, Borges-Costa J. Successful treatment with fusidic acid in a patient with folliculitis decalvans. Acta Dermatovenerol Croat. 2019,27(1):49-50. doi:
- Le Calvé C, Abi-Rached H, Vicentini C, et al. Treatment of folliculitis decalvans by photodynamic therapy using a new light-emitting device: a case series of 4 patients. JAAD Case Rep. 2021,17:69-72. doi:10.1016/j.jdcr.2021.09.026
- Pindado-Ortega C, Saceda-Corralo D, Miguel-Gómez L, et al. Impact of folliculitis decalvans on quality of life and subjective perception of disease. Skin Appendage Disord. 2018,4(1):34-36. doi:10.1159/000478053
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)