Effective treatment of folliculitis decalvans with cyclosporin: A case series

Abstract

Effective treatment of folliculitis decalvans with cyclosporin:A case series Folliculitis decalvans is a neutrophilic cicatricial alopecia that preferentially affects the scalp vertex and occiput. Therapy aims to arrest inflammation and prevent hair loss.Response to antibiotic and anti-inflammatory treatments is unpredictable, resulting in a sometimes chronic, recalcitrant course. 1 We report three patients with refractory folliculitis decalvans responding to cyclosporin. In the absence of a validated outcome measure for folliculitis decalvans, we considered photographic and symptomatic improvement; maintenance of the same therapeutic dose; and ability to taper therapy in assessing treatment response. CASE 1A 60-year-old Caucasian male had a 5-year history of treatment-resistant folliculitis decalvans affecting the vertex (Table 1). Cyclosporin 25 mg twice daily (0.81 mg/kg) was added to finasteride, oral minoxidil, minocycline and topical clindamycin. After 2 months, symptoms started improving; at 9 months, good disease control was achieved without adverse effects. Cyclosporin was slowly withdrawn after a total of 19 months of therapy, with relapse noted 5 months after discontinuation.