Oral isotretinoin as the most effective treatment in folliculitis decalvans: a retrospective comparison of different treatment regimens in 28 patients

Abstract

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.

Folliculitis decalvans‐like pustular plaques on the limbs sparing the scalp

“…The aetiology and pathogenesis of folliculitis decalvans remain to be elucidated. The primary process in folliculitis decalvans is a pustular folliculitis usually related to Staphylococcus aureus . There appears to be an exaggerated response to the organisms and the staphylococcal super antigen with prominent triggering of the innate immunity pathway.…”

“…A long‐term review will be required as folliculitis decalvans is prone to relapse following the regime that we have pursued. Further relapses may need the addition of other modes of therapy such as oral isotretinoin, photo‐dynamic therapy (PDT), oral corticosteroids, Nd:YAG laser, dapsone, finasteride and hydroxychloroquine …”

“…The primary process in folliculitis decalvans is a pustular folliculitis usually related to Staphylococcus aureus. 7 There appears to be an exaggerated response to the organisms and the staphylococcal super antigen with prominent triggering of the innate immunity pathway. One of the characteristic aspects of the histopathology of folliculitis decalvans on the scalp is the dual pathology that targets damaged follicles, characterised by progressive concentric perifollicular fibrosis and lichenoid lymphocytic inflammation.…”

Clarithromycin, rifampicin and fusidic acid triple combination therapy for chronic folliculocentric pustulosis of the scalp

“…Clarithromycin has additional immunomodulatory effects and can be used as monotherapy. It has been reported to be as effective as clindamycin, but gives longer remission rates than clindamycin or rifampicin, plus it has less risk of inducing Clostridium difficile ‐associated diarrhoea.…”

Isotretinoin treatment for folliculitis decalvans: a retrospective case‐series study

“…Approximately 50% of all FD patients maintain a lesion‐free state with prolonged continuous (up to 12 years) oral antibiotic treatment and experience flare‐ups when treatment is discontinued . One study reported that 57–80% of FD patients relapse after oral antimicrobial treatment …”