- Miguel-Gomez L.
- Rodrigues-Barata A.R.
- Molina-Ruiz A.
- et al.
- Miguel-Gomez L.
- Rodrigues-Barata A.R.
- Molina-Ruiz A.
- et al.
|Study design, study||Previous treatment failure||Cohort description||Treatment regimen||Treatment adverse effects||Treatment outcome||Outcome from ACP grading|
|1) Retrospective, multicenter review [Vano-Galvan et al; J Eur Acad Dermatol Venereol. 2015; 29(9):1750-57]||Not mentioned||82 total patients; 52 were men; mean age 35 y; 17 (21%) had severe disease||39 patients doxycycline for 3-6 mon||None||Doxycycline: 90% improvement, remission (mean 4.8 mon)||Grade 3|
|15 patients clindamycin and rifamicin for 10 wk||Clindamycin and rifampicin: 100% improvement, remission (mean 7.2 mon)|
|6 patients azithromycin 3x/wk for 3 mon||Azithromycin: 100% improvement, remission (mean 4.6 mon)|
|2) Retrospective, single-center, observational study [Tietze et al; J Eur Acad Dermatol Venereol 2015; 29(9):1816-21]||Clindamycin, rifampicin, clarithromycin, dapsone||28 total patients; 26 were men; age range 19-64 y||IST (0.2-0.5 mg/kg) for 5-7 mon||None||Complete remission with IST in 9 (90%) patients for 4 mon-2 y||Grade 3|
|Dosage tapered after remission achieved to 10 mg 2-3x/wk in 3 patients||3 (30%) patients required maintenance on low-dose IST|
|Follow-up range 2 mon-15 y||Relapse rates with antimicrobials: clindamycin and rifampicin 8 (80%) patients, clarithromycin 6 (67%) patients, ciprofloxacin or doxycycline 7 (78%) patients, dapsone 4 (57%) patients|
|3) Retrospective, single-center, observational study [Bunagan et al; J Cutan Med Surg. 2015; 19(1):45-9]||Not mentioned||23 total patients; 6 men; follow-up period 3 mon-13 y||A. ILT + clobetasol propionate lotion + (doxycycline 100 mg bid, minocycline 100 mg bid, or tetracycline 500 mg bid) (n = 10)||None||A. FD in remission in 7/10 (70%) patients, treatment discontinued||Grade 3|
|B. Cephalexin + ILT + clobetasol propionate lotion (n = 6)|
|C. Clindamycin + rifampicin (n = 1)||B. FD inactive in 6/6 patients with continued treatment|
|D. ILT + clobetasol propionate lotion (n = 1)||C. FD in remission in 1/1 patient, treatment discontinued|
D. FD in remission in 1/1 (100%) patient, treatment discontinued (The ILT+clobetasol proprionate lotion n=1 line)
|E. Multiple combinations (cephalexin, minocycline, tetracycline, rifampicin, clindamycin, ciprofloxacin, IST, dapsone) (n = 5)||E. FD under control in 2/5 (40%) patients with continued treatment, FD still active in 3/5 (60%) patients despite treatment|
|4) Single-center case series; nonblinded, nonrandomized study [Sillani et al; Int J Trichol Jan 2010; 2(1):20-3]||Not reported||13 total patients; 11 were male; mean age 30.1 (range 15-66) y||Mild FD (n = 8): minocycline 100 mg po bid||1 patient developed nausea and vertigo from rifampicin||Mild FD: minocycline 100 mg bid for average of 5.7 wk cleared inflammatory scalp lesions in 7/8 patients, 1/8 needed 2-wk acitretin rescue therapy, 1/8 exhibited FD relapse after 8 mon||Grade 3|
|Moderate FD: minocycline 100 mg po bid + rifampicin 150-300 mg bid||Moderate FD cases: combination of minocycline and rifampicin for average of 11.7 wk effective in treating 3 patients, clarithromycin + rifampicin for average of 10 wk effective in clearing scalp lesions in 2 patients (1 mild FD, 1 moderate FD)|
|Adjuvant drugs used included topical fusidic acid or mupirocin, selenium sulfide shampoo, oral compound glycyrrhizin, and zinc gluconate||9/13 patients partial hair growth responders (<75%)|
|5) Case series study [Powell et al; Br J Dermatol. 1999; 140(2): 328-33]||Flucoxacillin, erythromycin, minocycline||18 total patients; 13 were men; age range 18-62 y||Clindamycin 300 mg bid and rifampicin 300 mg bid for 10 wk||1 patient developed rash from clindamycin||FD in remission for 2-22 mon in 10 (55.6%) patients after 10-week course; FD in remission in 15 (83.3%) patients after 2-3 more 10-week courses||Grade 3|
|6) Retrospective, multicenter review [Miguel-Gomez et al; J Am Acad Dermatol. 2018; Epub ahead of print]||Not reported||60 total patients; 37 were men; median age 40 (range 23-83) y||Topical steroids (n = 48), topical antibiotics (n = 37), tetracycline (n = 36), intralesional steroids (n = 25), rifampicin and clindamycin (n = 21), oral isotretinoin (n = 15), photodynamic therapy (n = 8), oral steroids (n = 5), azithromycin and dapsone (n = 4), topical tacrolimus (n = 3), hydroxychloroquine and minoxidil (n = 2)||Epigastralgia, diarrhea, and headache associated with tetracyclines in 4 patients; hypercholesterolemia, arthralgias, and epistaxis in 3 patients treated with isotretinoin||Tetracyclines used in moderate and severe FD patients (n = 36) had 91% response rate; in refractory cases, rifampicin + clindamycin most effective, with 90.5% response rate and longer response duration (5 mon)||Grade 3|
|7) Retrospective, case series study [Aksoy et al; Int J Dermatol. 2018; 57(2):250-253]||Not reported||39 total patients, all male; mean age 37.85 (range 16-82) y||Oral isotretinoin 0.1-1.02 mg/kg/d for median 2.5 (range 1-8) mon; patients responding to treatment (n = 36) were subgrouped by daily dose (<0.4 mg/kg, ≥0.4 mg/kg) and duration (<3 mo, ≥3 mo)||Hyperlipidemia (35.9%), intractable xerosis (10.3%)||36 patients had partial and complete response after isotretinoin treatment, 61.5% patients had response to IST within 1 mon; 66% patients receiving IST <3 mo relapsed; patients that received oral IST ≥0.4 mg/kg/d for ≥3 mo had best response to IST, 66% no disease relapse||Grade 3|
|Study design||Previous treatment failure||Patient description||Treatment regimen||Treatment adverse effects||Treatment outcome||Outcome from ACP grading|
|1) Retrospective, case report [Collier et al; Clin Exp Dermatol. 2017; doi: 10.1111/ced.13238]||Doxycycline, rifampicin, clindamycin, IST, acitretin, CS, CsA||26-year-old man||Systemic PDT with ultraviolet light (100-140 J/cm2) with 1 mg/kg porfimer sodium||None||FD in remission at 25 mon follow-up||Grade 4|
|2) Retrospective, case series [Burillo-Martinez et al; J Am Acad Dermatol. 2016;74(4): e69-70]||Oral and intralesional CS, antibiotics||3 patients; all men; mean age 30 y||PDT; mean of 11 sessions over mean 9 mon; concurrent treatment with sulfamethoxazole-trimethoprim||All patients experienced pain and erythema; 1 patient exhibited worsening of condition||2 patients mild improvement after PDT session but relapsed before next cycle; 1 patient worsening of FD during treatment, required oral CS||Grade 4|
|3) Retrospective, case report [Elsayad et al; Strahlenther Onkol. 2015; 191(11): 883-8]||Tetracycline, rifampicin, cefaclor, clarithromycin, linezolid, CS, CsA, IST||45-year-old man||First course radiotherapy: 5 Gy in 5 fractions; second course radiotherapy: 6 Gy in 5 fractions 5 mon later||Mild pain, erythema, and transient increased scalp exudate||FD and associated symptoms significantly improved especially pain and pruritus at 12 mon follow-up||Grade 4|
|4) Prospective, single-center, case series [Miguel-Gomez et al; J Am Acad Dermatol. 2015;72(6): 1085-7]||Doxycycline, IST, rifampicin||10 patients; 5 men||PDT with MAL (methyl aminolevulinate hydrochloride)∗ 160 mg/g cream at 4-wk interval; area treated with red light at 630 nm with total light dose of 37 J/cm2; 2 patients concurrent doxycycline and intralesional CS||6 (60%) patients experienced local reaction post-PDT and pain||FD in remission for 9 (90%) patients; duration of remission 2-36 months (mean 9.9 mon); No. of patients and (no. sessions): 1(13), 1(9), 1(6), 1(5), 3(4), 1(3)||Grade 4|
|5) Retrospective, case report [Ismail et al; J Dermatolog Treat 2015; 26(5):471-2]||Clindamycin, rifampicin||27-year-old man||IVIG 2 g/kg first month then reduced to 1 g/kg from second to fourth month; concurrent flucloxacillin up to 3 infusions||None||FD in remission at 6 mon follow-up||Grade 4|
|6) Retrospective, single-center, case series [Kreutzer et al; J Dtsch Dermatol Ges 2014;12(1): 74-6]||Clindamycin, rifampicin, dapsone, methotrexate, oral CS, IST||2 patients; all women; age 58 and 50 y||Adalimumab 40 mg every 2 wk||None||FD in remission after 2-3 mon treatment; long-term follow-up unavailable||Grade 4|
|7) Case report [Meesters et al; J Dermatolog Treat 2014;25(2): 167-8]||Tetracycline, erythromycin, doxycycline, flucloxacillin, IST||34-year-old man||Long-pulsed Nd:YAG 1064-nm laser; started at 30 J/cm2 for 50 ms; dose increased to 50 J/cm2 with reduced pulse duration to 30 ms; total of 9 treatments, 8–12-wk interval||Pain and mild crusting but relived with topical lidocaine ointment and oral tramadol 50 mg during treatment||FD in remission at 1.5 y follow-up||Grade 4|
|8) Retrospective, case report [Mihaljevic et al; J Dtsch Dermatol Ges 2012;10(8): 589-90]||IST, oral CS, oral antibiotics, dapsone and zinc||45-year-old man||Infliximab 5 mg/kg every 4-6 wk||None||FD in remission after 3 infusions until 12 mon follow-up||Grade 4|
|9) Retrospective, case report [Castano-Suarez et al; Photodermatol Photoimmunol Photomed. 2012;28(2): 102-4]||Topical CS, IST, dapsone||32-year-old woman||PDT with MAL (methyl aminolevulinate hydrochloride);∗ 630 nm delivered at 37 J/cm2; 3 cycles over 8-wk period; each cycle involved 2 treatments 2 wk apart||Mild itching||FD in remission at 12 mon follow-up after last treatment||Grade 4|
|10) Retrospective, case series [Bastida et al; Int J Dermatol. 2012; 51(2): 216-20]||Acitretin, dapsone, oral and topical CS, antibiotics||4 patients; 3 were women; age 23-40 years||Tacrolimus (0.1%) ointment bid; 1 patient had combination treatment with doxycycline 100 mg/d||None||FD in remission at follow-up (range 2 mon-2.5 y); relapse occurred shortly after treatment discontinued||Grade 4|
|11) Retrospective, case report [Parlette et al; Dermatol Surg. 2004;30(8): 1152-4]||Dicloxacillin, tetralysal, doxycycline, minocycline, levofloxacin, ILT, IST, 1 course radiation||26-year old man||Nd:YAG laser at 28 J/cm2, 3-msec pulse duration, a 12-mm spot, and dynamic cryogen spray cooling set at 50-msec spray and 20-msec delay; patient received 8 treatments at 4-wk to 6-wk intervals||Significant pain during treatment||FD in remission at 6 mon follow-up||Grade 4|
|12) Retrospective, case report [Gemmeke et al; Acta Dermatovenerol Alp Pannonica Adriat. 2006; 15(4):184-186]||Prednisolone, ampicillin||27-year-old man||IST 30 mg/d, oral clindamycin 300 mg/d for 6 wk, prednisolone 20 mg/d tapered within 3 wk||None||At 3 wk, marked reduction in inflammation and partial regrowth in nonscarred scalp areas; at 6-mon follow-up, no disease progression||Grade 4|
|13) Retrospective, case report [Kaur et al; J of Dermatol. 2002;29(7): 180-181]||Multiple short courses of low-dose corticosteroids and antibiotics||42-year-old man||Rifampicin 600 mg po 1x/d; topical 2% mupirocin ointment||None||At 2 wk, pain and folliculitis disappeared, and no new pustules formed; alopecia did not extend but scarring persisted; complete resolution of FD at 6-mon follow-up||Grade 4|
|14) Retrospective, case report [Kunte et al; J Am Acad Dermatol. 1998;39(5 Pt2): 891-3]||Flucloxacillin, IST, topical superpotent CS||27-year-old man||Dapsone 100 mg/d||None||FD in remission for 18 mon||Grade 4|
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- Folliculitis decalvans: a multicentre review of 82 patients.J Eur Acad Dermatol Venereol. 2015; 29: 1750-1757
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- 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: 1816-1821
- Retrospective Review of folliculitis decalvans in 23 patients with course and treatment analysis of long-standing cases.J Cutan Med Surg. 2015; 19: 45-49
- Isotretinoin treatment for folliculitis decalvans: a retrospective case-series study.Int J Dermatol. 2018; 57: 250-253
Funding sources: Supported by the NIH 5 T32 AR 7569-22 National Institutes of Health T32 grant (to Ms Rambhia and Dr Conic).
Conflicts of interest: None disclosed.
Previously presented: This work was presented at the American Hair Research Summit in Orlando, Florida, May 14-16, 2018, and the 15th European Academy of Dermatology and Venereology Spring Symposium in Budva, Montenegro, May 3-6, 2018.