Objective: To elaborate the effectiveness of different antimicrobial agents in folliculitis decalvans (FD) patients attending our hair clinic.
Methods: Thirteen cases of FD attending our hair clinic between December 2008 and December 2009 were enrolled and their clinical, laboratory, histopathological findings and response to antimicrobial agents evaluated.
Results: 13 patients (Male/female = 11/2), mean age 30.08 ± 13.35 years were evaluated. Course of disease varied from 2 weeks to 4 years.84.6% (11 cases) had vertex involvement,61.5 % (8 cases) also had occipital involvement. Eight of the cases were considered as mild, the rest being considered as moderate FD, based on the clinical presentation, type of skin lesions, the area involved and duration of the disease. Six cases were confirmed histologically as FD with typical folliculitis and features of scarring alopecia.Staphylococcus aureus, citrobacter koseri and coagulase-negative staphylococcus were grown in 3 different cases, but no microorganisms were found in other cases. Separate courses of minocycline 100mg twice daily was used in mild FD patients whereas moderate severity and resistant cases were given a combination of minocycline and rifampicin 150-300mg twice daily. Additional clarythromycin 250mg twice daily and/or acitretin 10mg once to twice daily was given for those with unsatisfactory results. Overall, the therapeutic effects were clinically and cosmetically satisfactory,yet a delay in seeking treatment in one case led to permanent hair loss in the involved area. To date, follow-up data shows that in 6 cases no relapse has occurred, one patient had a flare-up after 8 months whereas 3 patients are still under treatment.
Conclusion: We obtained satisfactory results with minocycline and rifampicin in our FD cases. Relatively rapid remission was attained with partial to complete hair regrowth. However, some patients needed aggressive treatment with additional clarythromycin and acitretin for effective results.