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Leczenie łysienia związanego z łysieniem mieszkowym
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.
Discussion
Our case studies show that PDT sessions resulted in stabilization of FD and a decrease in symptoms in all 4 patients, with excellent tolerance (VAS, 0-2/10). All patients indicated that the reduction of symptoms resulted in a significant improvement of their quality of life (not assessed with a standardized score). The PDT sessions of the first patient were performed at 37 J/cm 2 , and the PDT sessions of the next 3 patients were performed at 12 J/cm 2 , according to the device available at the time. There was no difference between light irradiation of 12 and 37 J/cm 2 in the effectiveness of treating actinic keratosis. 7 One patient was prescribed adalimumab during PDT sessions, which may have had a synergistic effect against FD.
The reported clinical results of treatment of FD with PDT are variable. 8 , 9 Miguel-Gomez et al 3 reported a prospective series of 10 patients treated by conventional PDT. Nine patients (90%) showed clinical improvement, and 6 patients (60%) had a persistent remission. The main side effect was pain. In contrast, in a study by Burillo-Martinez et al, 10 PDT resulted in no improvement in all 3 patients and an overall worsening of the disease in 1 patient. All patients experienced discomfort that lasted from 1 to 3 days.
Despite encouraging results in the treatment of FD, conventional PDT has 2 main disadvantages compared with textile PDT: variability of light delivery and pain. These 2 parameters are improved by using new light-emitting devices. 7 , 11 , 12 On the basis of our clinical experience, we believe that monthly to weekly sessions are required until the symptoms are controlled. The disease often recurs a few months after the sessions are stopped. 1 To avoid recurrence, regular sessions of PDT could be performed. Furthermore, a well-tolerated illumination device, such as textile PDT, facilitates multiple sessions.
Systemic antibiotic therapy is currently the first-line treatment for FD, but it can increase bacterial resistance. Higher resistance rates of S aureus were shown in a cohort of patients with FD. 13 Photodynamic therapy has antibacterial effects, with no resistance, and provides local immunomodulation, 4 , 14 which could help reduce the use of repeated antibiotic therapies and the risk of bacterial resistance. The bactericidal effect of PDT on S aureus biofilm has been shown in vitro, with more than 99% of bacteria killed after the treatment. 15
Folliculitis Decalvans: What You Should Know
Inflammation in your hair follicles that leads to patchy hair loss is known as folliculitis decalvans. It may also involve itching, redness, blister-like pimples, and sores.
It’s typical to shed between 50 and 100 hairs a day. However, noticeably thinning hair, baldness, and skin irritation may warrant an investigation.
Hair loss (alopecia) is a relatively common condition, according to the American Academy of Dermatology. Short-term conditions, such as pregnancy, may cause temporary hair loss. But long-term hair loss that leads to bald patches may stem from an underlying medical condition. Folliculitis decalvans (FD) is one of the possibilities.
FD stems from widespread inflammation within the hair follicles. This causes the follicles to lose hair and stop producing new ones. It can also lead to other inflammatory symptoms.
Learn more about FD and how you can manage this condition. While there’s no cure, treatment can prevent further balding, sores, and scarring.
Inflammation in the hair follicles eventually leads to a variety of noticeable symptoms. FD may cause itching, inflammation, tenderness, tight feeling scalp, and, rarely, you may have no symptoms at all. Unlike genetic hair loss in which you might only experience hair thinning, FD also includes inflammatory symptoms.
Over time, you may notice the following signs on the scalp:
- redness
- swelling
- pustules (blister-like pimples that contain pus)
- scars
- tufting of hairs
- scaling
- crusting
- sores
Hair loss from this condition often occurs in irregular patches.
Alopecia is perhaps most noticeable on the scalp because that’s the area of the body with the most hair. However, alopecia can occur in the following areas:
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.
Successful Management of Folliculitis Decalvans
This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Folliculitis decalvans (FD) is a rare disease that causes inflammation on the scalp, leading to scarring alopecia. It commonly affects young and middle-aged men and is characterized by pustules, papules, scarring, hemorrhagic crusts, and erosions. The exact cause of FD is not fully understood, but it is believed that Staphylococcus aureus may play a role in its development. The condition is thought to be influenced by a combination of genetic, allergic, infectious, and immunological factors. This report describes a 20-year-old male patient who experienced painful pustules on his scalp for six months. The pustules first appeared on the occipital region and then spread to the crown. The patient was diagnosed with FD after a thorough clinical and pus culture examination. Treatment involved a month-long prescription of doxycycline (100 mg BD) and topical ozenoxacin (2%), which led to successful remission of the lesions.
Keywords: staphylococcus aureus, antibiotics therapy, oral doxycycline, scalp nodule, cicatricial alopecia