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Jawade S, Singh S, Quazi S, Dudhe M, Neazee S, Meghe SR, Jawade S. Effective Treatment of Folliculitis Decalvans With a Combination of Oral Isotretinoin and Rifampicin. Cureus 2024; 16:e60633. [PMID: 38903375 PMCID: PMC11187474 DOI: 10.7759/cureus.60633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/19/2024] [Indexed: 06/22/2024] Open
Abstract
Folliculitis decalvans (FD) is a rare type of inflammatory scalp disorder that leads to scarring alopecia. It is classified as primary neutrophilic cicatricial alopecia. FD presents a challenging scenario in clinical dermatology due to its rarity, resistance to treatment, and potential for scarring alopecia. This inflammatory scalp disorder primarily affects middle-aged adults, predominantly males. While its exact pathogenesis remains uncertain, a deficient host immune response to Staphylococcus aureus infection is hypothesized. Therapeutic interventions for FD pose difficulties, with limited treatment options available A 58-year-old female patient presented with a history of follicular papules that gradually progressed to form clusters of pustules, crusting, and hemorrhagic lesions with tufting of hairs on the crown area of the scalp, and was diagnosed with FD. Considering isotretinoin's role in inhibiting abnormal keratinization and inflammation, and rifampicin's ability to eradicate S. aureus, the combination of both provides a comprehensive approach to tackling the underlying factors contributing to FD. Despite previous unsuccessful treatments, combination therapy with isotretinoin and rifampicin yielded a remarkable outcome, prompting further exploration of this approach.
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Affiliation(s)
- Sugat Jawade
- Dermatology, Venereology, and Leprosy, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Sudhir Singh
- Dermatology, Venereology, and Leprosy, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Sabiha Quazi
- Dermatology, Venereology, and Leprosy, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Mayur Dudhe
- Dermatology, Venereology, and Leprosy, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Sabha Neazee
- Dermatology, Venereology, and Leprosy, Datta Meghe Medical College, Datta Meghe Institute of higher education and research, Nagpur, IND
| | - Soham R Meghe
- Dermatology, Venereology, and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapna Jawade
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Doche I, Hordinsky MK, Valente NS, Sotto MN, Miotto I, Rebeis M, Rivitti-Machado MC. Evidence for lymphocytic inflammation in non-lesional scalp of folliculitis decalvans: an observational study of 25 patients. J Eur Acad Dermatol Venereol 2021; 36:e109-e111. [PMID: 34510547 DOI: 10.1111/jdv.17649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/02/2021] [Indexed: 02/04/2023]
Affiliation(s)
- I Doche
- Department of Dermatology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - M K Hordinsky
- Department of Dermatology, University of Minnesota Medical School, São Paulo, Brazil
| | - N S Valente
- Department of Dermatology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - M N Sotto
- Department of Pathology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - I Miotto
- Department of Dermatology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - M Rebeis
- Department of Dermatology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - M C Rivitti-Machado
- Department of Dermatology, University of Sao Paulo Medical School, São Paulo, Brazil
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Halley-Stott RP, Adeola HA, Khumalo NP. Destruction of the stem cell Niche, Pathogenesis and Promising Treatment Targets for Primary Scarring Alopecias. Stem Cell Rev Rep 2020; 16:1105-1120. [PMID: 32789558 DOI: 10.1007/s12015-020-09985-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The Primary Scarring Alopecias are characterised by the irreversible destruction and fibrosis of hair follicles, leading to permanent and often disfiguring loss of hair. The pathophysiology of these diseases is not well understood. However, follicular-fibrosis and loss of the stem-cell niche appears to be a common theme. This review explores the pathogenesis of primary scarring alopecias, asking what happens to the stem cells of the hair follicle and how they may contribute to the progression of these diseases. Bulge-resident cells are lost (leading to loss of capacity for hair growth) from the follicle either by inflammatory-mediate apoptosis or through epigenetic reprogramming to assume a mesenchymal-like identity. What proportion of bulge cells is lost to which process is unknown and probably differs depending on the individual PCA and its specific inflammatory cell infiltrate. The formation of fibroblast-like cells from follicular stem cells may also mean that the cells of the bulge have a direct role in the pathogenesis. The identification of specific cells involved in the pathogenesis of these diseases could provide unique diagnostic and therapeutic opportunities to prevent disease progression by preventing EMT and specific pro-fibrotic signals.
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Affiliation(s)
- Richard P Halley-Stott
- Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa.
| | - Henry A Adeola
- Hair and Skin Research Laboratory, Groote Schuur Hospital, Cape Town, South Africa
| | - Nonhlanhla P Khumalo
- Hair and Skin Research Laboratory, Groote Schuur Hospital, Cape Town, South Africa
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Bolduc C, Sperling LC, Shapiro J. Primary cicatricial alopecia: Lymphocytic primary cicatricial alopecias, including chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and Graham-Little syndrome. J Am Acad Dermatol 2017; 75:1081-1099. [PMID: 27846944 DOI: 10.1016/j.jaad.2014.09.058] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 09/14/2014] [Accepted: 09/15/2014] [Indexed: 12/19/2022]
Abstract
Both primary and secondary forms of cicatricial alopecia have been described. The hair follicles are the specific target of inflammation in primary cicatricial alopecias. Hair follicles are destroyed randomly with surrounding structures in secondary cicatricial alopecia. This 2-part continuing medical education article will review primary cicatricial alopecias according to the working classification suggested by the North American Hair Research Society. In this classification, the different entities are classified into 3 different groups according to their prominent inflammatory infiltrate (ie, lymphocytic, neutrophilic, and mixed). Part I discusses the following lymphocytic primary cicatricial alopecias: chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and Graham-Little syndrome.
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Affiliation(s)
- Chantal Bolduc
- Department of Dermatology, University of Montreal, Montreal, Quebec, Canada.
| | - Leonard C Sperling
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jerry Shapiro
- Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada; Department of Dermatology, New York University, New York, New York
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Bolduc C, Sperling LC, Shapiro J. Primary cicatricial alopecia: Other lymphocytic primary cicatricial alopecias and neutrophilic and mixed primary cicatricial alopecias. J Am Acad Dermatol 2017; 75:1101-1117. [PMID: 27846945 DOI: 10.1016/j.jaad.2015.01.056] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 01/15/2015] [Accepted: 01/18/2015] [Indexed: 01/30/2023]
Abstract
Primary cicatricial alopecias can be frustrating for both patients and physicians. Proper diagnosis guides more successful management of these challenging conditions. Part II will cover the remaining lymphocytic primary cicatricial alopecias, which include pseudopelade of Brocq, central centrifugal cicatricial alopecia, alopecia mucinosa, and keratosis follicularis spinulosa decalvans. It will also discuss the neutrophilic and mixed primary cicatricial alopecias, namely folliculitis decalvans, dissecting cellulitis, folliculitis keloidalis, folliculitis (acne) necrotica, and erosive pustular dermatosis.
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Affiliation(s)
- Chantal Bolduc
- Department of Dermatology, University of Montreal, Montreal, Quebec, Canada.
| | - Leonard C Sperling
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jerry Shapiro
- Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada; Department of Dermatology, New York University, New York, New York
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Matard B, Cavelier‐Balloy B, Reygagne P. Epidermal psoriasiform hyperplasia, an unrecognized sign of folliculitis decalvans: A histological study of 26 patients. J Cutan Pathol 2017; 44:352-357. [DOI: 10.1111/cup.12892] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/25/2016] [Accepted: 01/03/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Bruno Matard
- Hôpital Saint‐LouisCentre Sabouraud Paris France
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Lee A, Cho S, Yam T, Harris K, Ardern-Jones M. Staphylococcus aureus and chronic folliculocentric pustuloses of the scalp - cause or association? Br J Dermatol 2016; 175:410-3. [DOI: 10.1111/bjd.14518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- A.H.Y. Lee
- Department of Dermatology; University Hospital Southampton NHS Foundation Trust; Southampton U.K
| | - S.Y. Cho
- Department of Dermatology; University Hospital Southampton NHS Foundation Trust; Southampton U.K
| | - T.S. Yam
- Department of Microbiology; University Hospital Southampton NHS Foundation Trust; Southampton U.K
| | - K. Harris
- Department of Microbiology; Great Ormond Street Hospital NHS Foundation Trust; London U.K
| | - M.R. Ardern-Jones
- Department of Dermatology; University Hospital Southampton NHS Foundation Trust; Southampton U.K
- Clinical Experimental Sciences; Faculty of Medicine; University of Southampton; Southampton General Hospital; Tremona Road Southampton U.K
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Tietze JK, Heppt MV, von Preußen A, Wolf U, Ruzicka T, Wolff H, Sattler EC. Oral isotretinoin as the most effective treatment in folliculitis decalvans: a retrospective comparison of different treatment regimens in 28 patients. J Eur Acad Dermatol Venereol 2015; 29:1816-21. [PMID: 25712452 DOI: 10.1111/jdv.13052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/19/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Folliculitis decalvans leads to scarring alopecia through inflammatory destruction of the hair follicle. Currently, antibiotics are most commonly used to treat this disease. However, treatment regimens with antibiotics feature a high relapse rate and encourage the development of resistant bacteria. OBJECTIVE To evaluate the outcome of different treatment options for folliculitis decalvans. METHODS Retrospective study to compare the efficacy of different treatment regimens in 28 patients with folliculitis decalvans. RESULTS The success of treatment with clindamycin and rifampicin, clarithromycin, dapsone and isotretinoin was analysed. The evaluation of the combination of clindamycin and rifampicin showed the lowest success rate in achieving long-term remission, since 80% of the patients relapsed shortly after end of treatment. Clarithromycin and dapsone were more successful with long-term and stable remission rates of 33% and 43% respectively. Treatment with isotretinoin was the most successful oral treatment in our analysis with 90% of the patients experiencing stable remission during and up to two years after cessation of the treatment. CONCLUSION The common use of antibiotics as first-line therapy in folliculitis decalvans needs to be re-evaluated critically and oral isotretinoin should be considered as valid treatment alternative.
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Affiliation(s)
- J K Tietze
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - M V Heppt
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - A von Preußen
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - U Wolf
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - T Ruzicka
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - H Wolff
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - E C Sattler
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
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Vañó-Galván S, Molina-Ruiz AM, Fernández-Crehuet P, Rodrigues-Barata AR, Arias-Santiago S, Serrano-Falcón C, Martorell-Calatayud A, Barco D, Pérez B, Serrano S, Requena L, Grimalt R, Paoli J, Jaén P, Camacho FM. Folliculitis decalvans: a multicentre review of 82 patients. J Eur Acad Dermatol Venereol 2015; 29:1750-7. [PMID: 25682915 DOI: 10.1111/jdv.12993] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/07/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Folliculitis decalvans (FD) is a rare neutrophilic scarring alopecia that represents a therapeutic challenge for dermatologists. OBJECTIVE To describe the epidemiology, comorbidities, clinical presentation, diagnostic findings and therapeutic options in a large series of patients with FD. METHODS This retrospective multicentre review includes patients diagnosed with FD based on clinical and histopathologic findings. The clinical severity was determined by the maximum diameter of the largest alopecic patch (slight: <2 cm, moderate: 2-4.99 cm, severe: 5 cm or more). Response to therapy was assessed as improvement, worsening or stabilization depending on the clinical symptoms (pruritus and trichodynia), inflammatory signs (erythema, pustules and crusts) and the extension of the alopecic patch. RESULTS Overall, 82 patients (52 males and 30 females) with a mean age of 35 years were included. No significant comorbidities were present. A family history was present in three males. Severe FD was observed in 17 patients (21%). The independent factors associated with severe FD after multivariate analysis were: onset of FD before 25 years of age and presence of pustules. Oral antibiotics (tetracyclines and the combination of clindamycin and rifampicin) improved 90% and 100% of the patients, with a mean duration of response of 4.6 and 7.2 months respectively. CONCLUSIONS The onset of FD before 25 years of age and the presence of pustules within the alopecic patch were associated with severe FD. Tetracyclines and the combination of clindamycin and rifampicin were the most useful treatments.
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Affiliation(s)
- S Vañó-Galván
- Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | | | | | | | - S Arias-Santiago
- Unidad de Dermatología Hospital Virgen de las Nieves, Instituto de Investigaciones Biosanitarias IBS, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | | | | | | | - B Pérez
- Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - S Serrano
- Universidad de Granada, Granada, Spain
| | - L Requena
- Fundación Jiménez Diaz, Madrid, Spain
| | - R Grimalt
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - J Paoli
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - P Jaén
- Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
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