Successful treatment of refractory folliculitis decalvans with apremilast

Tumor necrosis factor inhibitors and janus kinase inhibitors in the treatment of cicatricial alopecia: A systematic review

BACKGROUND

Cicatricial alopecia (CA) refers to various conditions that result in permanent hair loss. Treatment of CA has always been challenging. Regarding immune-mediated pathophysiology for many CA subtypes, the administration of Janus kinase (JAK) and tumor necrosis factor (TNF) inhibitors have potentiated the treatments of CA.

METHODS

After a thorough systematic search in PubMed/Medline, Embase, Web of Science, Scopus, Google Scholar, ClinicalTrials.gov, and WHO ICTRP, a total of 3,532 relevant records were retrieved and screened. Accordingly, 56 studies met the eligibility criteria and entered the review.

RESULTS

Among JAK inhibitors, oral tofacitinib was the most frequently reported and the most effective treatment in improving signs and symptoms of CA with minimal adverse effects (AEs). Baricitinib was another JAK inhibitor with sustained improvement while causing mild AEs. As a TNF inhibitor, adalimumab induced a rapid and stable improvement in signs and symptoms in most patients with rare, tolerable AEs. Thalidomide was the other frequently reported yet controversial TNF inhibitor, which caused a rapid and significant improvement in the condition. However, it may result in mild to severe AEs, particularly neuropathies. Infliximab is a TNF inhibitor with mostly favorable results, albeit in a few patients caused treatable dermatological AEs. Apremilast and certolizumab pegol caused an incomplete amelioration of signs and symptoms with no AEs. Lenalidomide is another TNF inhibitor that can induce temporary improvement in CA with probable AEs. It is noteworthy that utilizing adalimumab, infliximab, etanercept, golimumab, and an anonymous TNF inhibitor has induced paradoxical CA and other A.E.s in some patients.

CONCLUSION

Recent studies have recommended JAK and TNF inhibitors, especially oral tofacitinib and adalimumab, as a new modality or adjuvant therapy to previous medications for primary CA. Nonetheless, monitoring AEs on a regular basis is suggested, and further extensive studies are required before definitive recommendations.

Photodynamische Therapie als Therapieoption bei Follikulitis decalvans

Follikulitis decalvans ist eine seltene chronisch verlaufende Entzündung der Kopfhaut, die zur Zerstörung der Haarfollikel und Vernarbung führt. Obwohl die Ätiopathogenese nicht vollständig geklärt ist, gibt es Grund zur Annahme, dass die Follikulitis decalvans durch eine fehlgeleitete Immunantwort auf Kopfhaut assoziierte Mikroben begünstigt wird, insbesondere durch Staphylococcus aureus. Wir berichten von einem 51-jährigen Mann, der sich mit schmerzhaften follikulär gebundenen papulopustulösen Läsionen am Kapillitum in unserer Klinik vorstellte. Seit seiner Jugend zeigten systemische Therapien mit Doxycyclin, Clindamycin und 13-cis-Retinsäure nur kurzzeitig Wirkung. Wir leiteten eine photodynamische Therapie mit Methyl-5-amino-4-oxopentanoat (Metvix) und LED-Rotlicht, 37 J/cm2 ein. Nach 4 Zyklen zeigten sich die papulopustulösen Läsionen fast vollständig abgeheilt und ein diskreter Nachwuchs der Kopfbehaarung war zu verzeichnen.