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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.
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
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.
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
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: